Finally! A Proposal For Mandatory Minimum Staffing Standards For Long-Term Care Facilities.
I was so excited to see that the Centers for Medicare and Medicaid Services (CMS) issued minimum staffing standards for long-term care facilities. This proposed rule seeks to establish comprehensive nursing staffing requirements. I love this initiative because residents in nursing homes are not always given the best care due to short staffing. Although there are requirements that facilities must provide sufficient levels of staffing pursuant to the OBRA regulations, chronic understaffing is prevalent in long-term care facilities.
The rule proposes 0.55 hours per resident day for nursing care and 2.45 hours per resident day for nurse aids. There is also a requirement to have an RN on site 24 hours a day, seven days a week. It will be so interesting to see if this rule passes. It is open for comment and if you support the rule, I highly recommend that you comment so that your voice can be heard.
I’m sure the long-term care facilities are going to balk at this proposed regulation, but one of our most vulnerable populations, our elderly, deserves to have minimum care. Even a nurse for 0.55 hours per resident day, which is basically less than one hour of care for the entire 24 hours is questionable but hopefully with more nurse aides on staff, patients will get the care that they need.
Residents in long-term care facilities are medically complex and can be high acuity patients. Creating consistent standards will hopefully reduce the risk of unsafe and low-quality care across long-term care facilities.
I also love the idea that an RN be on staff seven days a week to provide direct resident care. While I think LPNs are fantastic, the assessment skills of a registered nurse are definitely needed.
The rule also states that the CMS wants to hold nursing homes accountable to ensure that residents receive safe and high-quality care. I hope that there is some mechanism to hold responsible facilities that do not comply with the mandatory minimum standards. CMS is proposing that it will take away federal funding if the facility fails to implement these mandatory minimum staffing requirements.
The CMS does discuss good faith efforts to hire and retain staff through development and implementation of a recruitment and retention plan but trying isn’t good enough. These residents deserve consistent care.
The plan is to stagger implementation. Phase one would require facilities in urban areas to comply with facility assessment requirement 60 days after publication of the final rule. Phase two would be for urban areas to comply with the requirement for an RN to be on site 24 hours a day, seven days a week. And phase three would require facilities in urban areas to comply with mandatory minimum staffing.
These would be three years after the publication date of the final rule. Seriously, I don’t think we can wait three years! While I understand that the rulemaking process takes time, this needs to be implemented now!.
The CMS does acknowledge that rural long-term care facilities face difficulty providing safe staffing as well. This rule has different requirements.
Although I know staffing is difficult in rural areas, if the facility is competitive, has a great working environment and pays well, they should not have a problem with staffing.
Your comments to this proposed rule are invited through November 6, 2023. I truly hope that you will comment so that our elderly, who are the most deserving of safe staffing can get the care they need.
