The Biden administration said Friday that the federal government will, for the first time, regulate staffing levels in nursing homes in response to systemic problems exposed by the mass COVID-19 deaths.
While allies of the elderly and disabled have sought such regulation for decades, the proposed threshold is far lower than many advocates would like. It also drew the immediate ire of the nursing home industry, which said it amounted to an impossible task.
Despite the expected criticism, President Joe Biden’s much-anticipated promises in his 2022 State of the Union address were revealed as many Americans stopped watching the news during the holiday weekend.
“We are working hard to ensure that no nursing home can increase profits at the expense of residents’ safety,” the president said in a USA TODAY op-ed.
The American Healthcare Association, which lobbies nursing facilities, called the proposal “unfathomable,” saying it would exacerbate existing problems and cost families billions of dollars.
“We want to convince the administration never to finalize this rule because it’s unfounded, unfunded and impractical,” said AHCA Chairman Mark Parkinson, a former Democratic governor of Kansas.
The proposed rule, which is now in a public comment period and will take years to fully take effect, would require the equivalent of three hours per resident per day, with more than half an hour from registered nurses. The rules also require facilities to have a registered nurse on staff 24 hours a day.
Nursing staff in U.S. nursing homes work an average of about 3.6 hours per resident per day, with registered nurses working a little over half an hour, according to government reports.
Still, the administration insists that most of the country’s roughly 15,000 nursing homes, which house about 1.2 million people, must add staff under the proposed rules.
Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services (CMS), called the move an “important first step.” CMS oversees nursing homes.
A senior White House official, speaking on condition of anonymity before the announcement, said the Biden administration was willing to review staffing thresholds after implementation.
Stacy Sanders, an aide to Health Secretary Xavier Becerra, said: “I would caution anyone who thinks the status quo — that there is no federal floor for nursing home staffing — is more critical than our proposed standards. Desirable people.” “This standard will increase staffing levels in nursing homes by more than 75 percent, bring more nursing assistants to the bedside, and ensure that every nursing home has a RN present 24/7.”
After a landmark 2001 CMS-funded study suggested that each resident received an average of 4.1 hours of care per day, the new threshold is substantially lower than what advocates have long focused on.
Most U.S. facilities do not meet this threshold. Even that is insufficient, many advocates say, without considering quality of life, only to determine the extent to which residents may suffer potential harm.
Supporters were initially elated after the Democratic president raised the issue in his State of the Union address, anticipating the most significant change for residents since the Nursing Home Reform Act of 1987. That changed after the release of a copy of a new CMS-funded study on nursing home reform. The thread was inadvertently posted this week, claiming that “there is no obvious platform for maximizing quality and security”.
Supporters are frustrated, saying they feel betrayed by government officials they consider allies. As news of the proposal became public earlier Friday, the reaction from some intensified.
Richard Mollot, leader of the Long-Term Care Communities Coalition, called it “completely inadequate” and a missed “once-in-a-lifetime opportunity” that “disregarded any evidence” of what residents needed and failed to deliver on promises. The core of Deng’s commitment. He begrudgingly concedes that the 24/7 RN rule can bring small improvements to the worst facilities, but his criticisms wither.
He called the move “heartbreaking” and “disgusting” and said it would do more harm than good, see the government recognize understaffed housing and jeopardize wrongful death lawsuits.
“It’s a huge dereliction of duty,” he said. “We continue to allow nursing homes to stockpile people and deceive the public.”
Current law only requires households to be “adequately” staffed, but leaves nearly all interpretation to the states. Thirty-eight states and the District of Columbia have their own staffing regulations. Some are so low that advocates say they’re pointless, and law enforcement, taken as a whole, is often helpless.
This problem has been apparent both to frontline nurse aides (underpaid, overwhelmingly female and disproportionately minority cadres of facility staff) and to residents themselves, whose call bells go unanswered and the more often they shower. Coming lower and lower, they waited hungry. Help with cooking.
The coronavirus pandemic has claimed the lives of more than 167,000 U.S. nursing home residents, sparking the greatest focus on understaffing in history. But with that, many households have become leaner.
Across all job types, nursing home employment was 218,200 fewer than it was in February 2020, when the first U.S. coronavirus outbreak hit nursing homes outside Seattle, according to the U.S. Bureau of Labor Statistics.
AHCA has waged a relentless campaign alleging crumbling facilities, inadequate Medicaid subsidies, pervasive hiring problems and mass housing closures. While there have been sporadic factory closures, the profitability of housing has been repeatedly exposed, with critics arguing that workers would come if they paid higher wages.
Katie Smith Sloan, head of LeadingAge, which represents nonprofit nursing homes, said rules requiring facilities to hire additional staff come at a time when the industry is already in a workforce crisis and “simply has no one to hire.” Meaningless.
“It would be an understatement to say we are disappointed by choosing to move forward with proposed staffing ratios despite clear evidence against President Biden,” she said.
