Advocates criticize CMS' omission of LPNs in nursing home staffing mandates

Nursing home groups and advocates are criticizing CMS' proposed nursing home standards for not allowing licensed practical nurses to count toward the requirements, Bloomberg Law reported Dec. 11.

Some said they are worried the omission could lead to facilities trying to lower costs by replacing LPNs with nursing aids and staffing registered nurses only to the required minimum. The potential scenario could lower the "skill mix" of direct care staff and hurt quality of care, Richard Mollot, executive director of the Long Term Care Community Coalition, told Bloomberg Law. It could also force registered nurses to assume more LPN duties.

However, CMS argued that better health outcomes were associated with increased staffing only for registered nurses and nursing aides, not LPNs. A CMS-commissioned study found no association "at any level" between LPN staffing and quality care. CMS also cited concerns that LPNs would perform tasks outside the scope of practice without sufficient supervision from registered nurses.

Sixteen senators sent a letter to CMS in September opposing the new standards and in November, Nebraska Sen. Deb Fischer said she plans to propose a bill that would prevent CMS' "misguided standards" from going into effect.

The nursing home workforce standards were released in September. According to CMS data, 94% of government-funded nursing homes were short-staffed during the pandemic, and many continue to struggle to maintain proper staffing levels.

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