This week, the American Hospital Association (AHA) sent letters to the Senate and House urging them to support legislation that would prevent the Centers for Medicare & Medicaid Services (CMS) from enforcing its final rule on minimum staffing requirements for long-term care facilities.
The organization argued that the establishment of minimum staffing requirements would stifle innovation in care delivery and possibly cause nursing homes to reduce capacity or shut down altogether — even if they’re performing well on quality and safety metrics.
CMS’ rule — which was finalized in April — requires all nursing homes that receive federal funding through Medicare and Medicaid to deliver 3.48 hours of daily direct care per patient. It also mandates that nursing homes must have at least one registered nurse on site 24 hours per day — a significant increase from the eight hours per day previously required by federal law.
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The rule also stipulates that 0.55 hours of this daily care must be provided by a registered nurse, and 2.45 hours of this care must be provided by nurse aides.
This means that a facility with 100 residents would need at least two or three registered nurses on staff each day, as well as 10-11 nurses aides and an additional pair of nurse staff, according to a White House fact sheet.
In its letter to the Senate, the AHA wrote that safely staffing any healthcare facility “is about much more than achieving an arbitrary number set by regulation.”
“It requires clinical judgment and flexibility to account for patient needs, facility characteristics and the expertise and experience of the care team. [CMS’] one-size-fits-all minimum staffing rule for long-term care facilities creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements,” the letter read.
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In both letters, the AHA called on Congress to disapprove the mandate and prohibit CMS from implementing or enforcing it.
The rule has received negative feedback from the nursing home industry ever since it was proposed last September.
For example, the American Health Care Association (AHCA) released a statement saying that the staffing mandate sets “an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors’ access to care.”
The AHCA also pointed out that some states have already enacted staffing mandates for nursing homes — and that facilities in those states have largely struggled to comply. For example, three-quarters of nursing homes in New York are failing to meet the state’s requirement of providing three and a half hours of care per resident per day, the organization said.
Labor unions are the only entities that seem pleased with the proposal. For instance, the Service Employees International Union (SEIU), praised the rule, calling it “a major step toward strengthening our long-term care workforce, ensuring quality care for those who need it and helping every family thrive.”
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