Reactions to the Finalized CMS Nursing Home Staffing Standards

On April 22, the Centers for Medicare & Medicaid Services (CMS) finalized the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting final rule.

The rule’s proposed minimum nurse staffing requirements generated significant discussion among the senior care industry. The finalized rule requires nursing homes to provide at least 3.48 hours of nursing care per resident day, including 0.55 hours of care from a registered nurse and at least 2.45 hours of care from a nurse aide per resident day. The rule also requires an RN to be onsite 24/7 to provide skilled nursing care.

The rule is presented as an effort to “significantly reduce the risk of residents receiving unsafe and low-quality care within LTC facilities.” The finalized rule allows for a staggered implementation timeframe of the minimum staffing standards based on a facility’s geographic location. Additionally, there is an option for facilities to possibly qualify for an exemption from some of these requirements.

I Advance Senior Care spoke with senior care industry experts to get their take on the finalized standards and what steps facilities can take to meet those standards.

How the Staffing Standards Will Impact Residents and Families

Dr. Ahzam Afzal, CEO & co-founder of Puzzle Healthcare

Dr. Ahzam Afzal, CEO & co-founder of Puzzle Healthcare, notes that increasing staffing can enhance quality of life for nursing home residents. “With a mandate for increased direct care hours per resident, the standards aim to ensure that each resident receives more personalized and attentive care. This heightened focus on individual care is crucial for improving both medical and emotional well-being,” he says. Afzal notes that increasing staffing means more staff will be available to manage residents’ daily needs, which can help reduce common issues like falls, medication errors, and preventable hospital readmissions.

“For families, the implications of these standards are equally significant,” he says. “Knowing that their loved ones are in a setting where care is abundant and accessible can alleviate stress and anxiety. It ensures that their family members are not only safe but are also being engaged with and cared for by skilled professionals on a more frequent basis.”

Carrie O’Connell, RN, vice president of clinical strategy, WellSky, notes that most nursing facilities will need to increase staffing based on the rule, which will have several implications. She explains that additional staff can improve resident safety, patient outcomes, and worker satisfaction. “With more staff on hand, there’s more time to allow residents to do things for themselves per their personalized care plan. This promotes independence and allows for residents to have more control throughout their day, which improves wellbeing,” she says.

However, O’Connell notes that the staffing requirements can have additional and problematic effects. “Unfortunately, residents and families in facilities that may struggle to meet this rule could be displaced as facilities are forced to reduce capacity and/or close,” she says. “For residents and families seeking a facility, they might struggle to find placement all together with reduced available beds.”

How the Staffing Standards May Impact Nursing Facilities

Carrie O’Connell, RN, vice president of clinical strategy, WellSky

O’Connell explains that the staffing standards will have a significant impact on nursing facilities in markets that are already facing a labor crisis. “Facilities are struggling to compete for the available nursing talent against higher-paying hospitals and emerging remote positions,” she says. “The issue is not just providing a competitive package to recruit and retain, but to find qualified individuals at all. It’s been estimated that 24,000 new registered nurses will be required to meet the standard, and nursing schools are struggling to expand capacity to meet the rising demand for care. Additionally, 77,000 aides will be required to fulfill the new standard.”

She highlights the fact that if facilities aren’t able to meet the requirement, they will have to reduce their capacity or close. “Hospitals are already seeing longer lengths of stay because they can’t find beds in post-acute care facilities for patients who are ready for discharge. The reduction in nursing facility bed availability impacts the entire healthcare eco-system,” explains O’Connell. She says that if hospitals can’t discharge safety, the patient must stay at a higher level of care than they actually need, which leads to increased costs.

This also means the hospital has fewer open beds for acute admissions. If the patient is discharged to an inappropriate level of care because of the lack of nursing facility beds, their risk of re-admission increases, along with the cost. “Reduced nursing home beds will threaten access to multiple types of care within the entire care continuum, which is especially of concern in rural and underserved communities,” she says.

Afzal highlights several immediate challenges that the staffing requirements will create. The first is recruitment and financial strain, as facilities must recruit and train additional staff to meet the mandated care hours. “This could impose a considerable financial burden, particularly for facilities that operate with tight budgets and rely heavily on Medicaid and Medicare reimbursements,” he says.

Additionally, facilities may face operational disruption resulting from the efforts of integrating new staff into existing workflows. “Facilities may need to overhaul their scheduling systems, enhance their training programs, and possibly even redesign care protocols to ensure that the increased staffing leads to effective care delivery,” explains Afzal.

Long-term, Afzal believes that the staffing requirements could prompt a cultural shift in facilities. “This mandate can serve as a catalyst for a broader cultural shift within facilities toward a more resident-centered care model. Increased staffing levels offer an opportunity to foster a more engaging, responsive care environment, which can enhance the overall workplace culture and attract more skilled caregivers,” he says.

Looking Forward

With many facilities not currently meeting the new staffing requirements, many facilities will face recruitment challenges. In part two of this series, Afzal and O’Connell share detailed recommendations to help facilities recruit staff and prepare to meet the new requirements.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.