- Two major hospital groups are pushing back against the CMS’ plans this year to issue federal staffing minimums for nursing homes, according to a Monday letter sent to CMS Administrator Chiquita Brooks-LaSure from the American Hospital Association and American Health Care Association.
- In the letter, the groups argue that federal staffing mandates are a “one-size-fits-all” approach to the labor crisis and that issuing mandates would further reduce capacity by forcing some nursing homes to shut their doors.
- The Biden Administration has focused on nursing home staffing, with the White House announcing last year that it was directing the CMS to create a set of reforms for nursing homes in wake of the pandemic, including minimum staffing standards.
Nursing homes suffered the worst job losses in the healthcare industry at the start of the pandemic and are still struggling to retain staff.
While hospitals and ambulatory care services have fully recouped all the jobs lost at the start of the pandemic, nursing homes and residential care facilities still haven't recouped about 27,000 jobs, according to a recent report from nonprofit Altarum.
Tight nursing home capacity has led to longer patient stays and delayed discharges for hospital patients throughout the pandemic.
“This has a detrimental impact on patients who must wait days, weeks, or even months in hospital beds awaiting discharge to post-acute care; the capacity of care providers to serve our communities; and the costs to the entire health care system,” the groups wrote in the letter.
Under Biden’s order, the CMS announced it would conduct research to find appropriate levels of staffing needed and would issue proposed rules within a year.
The Biden Administration has also been cracking down on nursing home ownership, particularly private equity ownership, with the CMS issuing a proposed rule in February that requires nursing homes to disclose ownership and management information to the agency.
Nursing homes participating in Medicare and Medicaid currently must provide 24-hour licensed nursing services sufficient in meeting residents’ needs, and must use a registered professional nurse’s services at least eight consecutive hours a day, every day, according to the CMS.
But understaffing is still a concern, with ratios informed by older care models that don’t consider modern capabilities with technology and new team care models, the groups wrote in the letter.
“In short, specific staffing levels should be a clinical decision customized to the resident population and facility characteristics rather than a policy decision made with lack of regard to real-life situations,” they wrote.
The groups suggest other tools to ease current healthcare staffing challenges, like Congressional action to create a temporary visa program for foreign-trained registered nurses. Other recommendations include policies to expand loan repayment and other incentive programs to attract and retain talent, they wrote.
The letter comes as federal nurse staffing ratio legislation was reintroduced in the House on Thursday, and as labor unions renewed their push for Congress to pass a bill related to nurse staffing levels in wake of the pandemic.
The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, introduced by Sen. Sherrod Brown, D-Ohio, and Rep. Jan Schakowsky, D-Ill., would set minimum nurse to patient ratios for all hospital units.
It mirrors California’s nurse staffing law, which outlines exactly how many patients a nurse in a specific unit can care for at once. It would also protect nurses who speak out against unsafe staffing levels.
Schakowsky also led House efforts urging the CMS to include nursing home staffing standards in the proposed fiscal year 2024 Medicare payment rule.