- Eighty-one percent of nursing home facilities nationwide and 90% of for-profit facilities would need to hire additional registered nurses or nurse aides to meet the minimum nursing staff hours standards proposed by the CMS earlier this month, according to a KFF estimate published Monday.
- The CMS introduced the guidance in response to longstanding concerns that inadequate staffing levels negatively affect nursing home residents’ care. The rule would require nursing homes to have a minimum of 0.55 RN and 2.45 nurse aide hours per resident day, and an RN on staff 24 hours per day, 7 days per week.
- Industry leaders immediately pushed back on the proposal, arguing that a nationwide nursing shortage would prevent facilities from meeting staffing targets. Staffing levels currently vary by type of facility and geography. In over half of states, less than a quarter of nursing facilities would meet the requirements under the proposed rule, according to the KFF study.
The COVID-19 pandemic had an outsized impact on the nursing home industry, as workers left positions in record numbers due to burnout, low wages and increased stress associated with caring for vulnerable populations during a public health emergency.
As of June, employment levels in long-term care facilities remained depressed at 11% below pre-pandemic levels industry-wide and 3% below pre-pandemic levels for workers in elder care facilities, according to the Bureau of Labor Statistics.
In light of current workforce shortages, industry leaders have argued that the CMS staffing proposal, which would be the first federal regulation mandating specific staffing levels in nursing homes, is untenable.
Mark Parkinson, president and CEO of the American Health Care Association, which represents over 14,000 skilled nursing facilities and assisted living centers, said in a statement that the policy would require homes to “hire tens of thousands of nurses that are simply not there.”
“It then penalizes us and threatens to displace hundreds of thousands of residents when we can’t achieve the impossible,” Parkinson said in a statement.
However, others didn’t think the proposal went far enough and had hoped the CMS would require 4.1 hours of nursing care per resident per day, a number first proposed by a CMS-funded 2001 study measuring the relationship between nursing care and patient outcomes.
Dr. Bianca Frogner, director of the UW Center for Health Workforce Studies at the University of Washington, told Healthcare Dive that concerns about a labor shortage in the industry are not overblown.
Currently, nursing facilities are competing with hospitals for talent, as RNs are steered toward hospital settings during their training. Larger systems also typically pay higher starting wages, she said.
When RNs do work in nursing homes, Frogner explained it can be a fraught environment where nursing assistants turn over at rates of 100% to 300% annually. The stress “reverberates through the system, because it conveys a feeling that nursing homes are not desirable places to work,” she said.
Attracting more RNs and nursing assistants would cost the industry an estimated $40 billion dollars over the next ten years, KFF estimates — a cost that is likely to be passed on to public and private payers, including residents and their family members. Already, residents paid $45 billion in out-of-pocket costs for care in nursing homes and other institutional long-term services and support settings in 2020, according to KFF.
Even with a sizable financial investment, Frogner is skeptical that nursing homes will be able to attract talent without additional investments in training and benefits, like healthcare or transportation.
“Even if they did offer good pay, they are struggling to find a pool of workers who can even fill these jobs,” Frogner said.
There are currently no firm answers as to how the CMS will audit compliance, and it’s unclear whether future federal budgets will have funds for nursing facility inspections and enforcement, according to KFF.