CMS pitches staffing ratios for nursing homes

CMS proposed installing staffing requirements in nursing homes Sept. 1, a few days after the agency posted, then unpublished, research that failed to find a recommended staffing level in skilled nursing facilities. 

The floated requirements include requiring long-term care sites to have one registered nurse on-site 24/7, 0.55 hours per resident day for RNs and 2.45 hours per resident day for nurse aides. These standards are higher than most states' rules, CMS said, and about 75 percent of nursing homes would have to increase their workforces if the proposal is approved. 

In response, the American Hospital Association raised concerns about the possible staffing requirement, arguing that "safe staffing is about much more than a number," and a new rule could worsen the rate of nursing home closures. The organization also said clinical judgment and a team member's experience ranks higher than a staffing threshold. 

"We commend the administration's plans to invest in education for health care staff, but training takes time," the AHA said. "We are concerned that implementing a numerical staffing threshold in two short years will not resolve the structural health care workforce shortages that have been building for more than a decade."

CMS also suggested adding a requirement for long-term care sites to uphold 3.48 hours per resident day for all staff, according to its fact sheet. The agency is seeking feedback on the 231-page proposal by Nov. 6. 

In late August, a CMS-commissioned study analyzed four minimum staffing levels below the preferred 4.1 level, which ranged from 3.88 daily staffing hours to 3.3 daily staffing hours. The research could not conclude which was the best option for improving quality, and CMS' principal deputy administrator and COO said the study was a draft and accidentally posted.

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