CMS proposes minimum staffing standards for nursing homes

Nate Schema, President and CEO at The Evangelical Lutheran Good Samaritan Society

On Sept. 1, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would establish minimum staffing standards for nursing facilities. A minimum staffing level sets required hours of direct care nursing for residents, regardless of facility size, location or resident need.

Long-term care providers across the nation are dealing with historic workforce challenges following the COVID-19 pandemic, and the situation is even more urgent in rural areas.

Lack of staff is the predominant factor that has led to 55% of nursing homes nationwide limiting admissions and 579 nursing homes to permanently closing since the pandemic.

If the rule is finalized as proposed, nursing homes that cannot find caregivers to meet the requirements will be at risk of closing or limiting admissions.

When a rural nursing home closes, the nearest one is often an hour or more away. Fewer available skilled nursing beds also make it more difficult for hospitals to discharge patients who need short-term rehabilitation or long-term care.

“We share a commitment with CMS to provide access to high-quality care to our nation’s seniors,” says Nate Schema, president and CEO of the Good Samaritan Society. “A minimum staffing mandate is the wrong solution. There are simply not enough caregivers available to meet the proposed requirements despite our around-the-clock recruitment and retention efforts.” 

A Clifton Larson Allen report found that nursing homes would need to hire an estimated 100,000 nurses and nurse aids to meet the requirements as proposed. At the Society, this equates to an additional 370 registered nurses and 364 nurse aids.

What is a viable path going forward?

CEO Nate Schema and more than 600 leaders across the Good Samaritan Society shared feedback with CMS on the proposed rule and alternative solutions.

“Rather than setting unattainable staffing standards that will accelerate rural access disparities, we are advocating for solutions that will strengthen the long-term care workforce so we can continue to meet the comprehensive and evolving needs of our seniors, wherever they call home,” Nate says.

The Society supports:

  • A regulatory pathway to allow virtual registered nurse support in nursing homes in the evenings and overnight.
  • The bipartisan Healthcare Workforce Resilience Act that would recapture unused visas to welcome 25,000 internationally-educated nurses and 15,000 physicians to the U.S. to help meet the urgent demand for clinicians.
  • Funding for any increased staffing requirements.
  • Including licensed practical nurses in the nursing staff calculations. LPNs are a critical component of a nursing home’s care team.
  • Delaying any minimum staffing requirement until the long-term care workforce recovers.

What’s next?

Nearly 47,000 comments were submitted to CMS during a 60-day comment period that ended on Nov. 6. CMS must review each comment before finalizing the rule.

Read more from Nate Schema about how the Good Samaritan Society is addressing workforce challenges

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