The Biden administration’s plan to gradually implement proposed nursing home staffing requirements over five years is causing concern among industry officials, state regulators, and patient advocates for a variety of reasons.
According to the proposed rule (RIN 0938-AV25) from the Department of Health and Human Services, urban nursing homes would have three years to increase staffing for registered nurses and nursing aides, while rural nursing homes would have five years. The proposed rule is looking to enforce round-the-clock registered nurses in urban facilities two years after its finalization and three years for rural facilities to comply with this requirement.
There is a disparity in opinions regarding the implementation timeline. Industry trade groups are advocating for five years for all facilities to implement most of the new requirements due to ongoing labor shortages. In contrast, state officials, consumer groups, and many long-term care experts believe that a two to three-year timetable is more appropriate.
The final rule will determine how long nursing homes can wait to add needed staff, taking into account both the urgent need for improved care and the industry’s concerns about the rule’s estimated $4 billion annual cost. However, David Grabowski, a professor of health-care policy at Harvard Medical School, highlighted the difficulty in making these assessments due to a lack of accurate data on nursing home finances.
The proposed rule, if finalized, would require a minimum overall nurse staffing level of 3.0 hours per resident per day, with 2.45 hours required for nursing aides and 0.55 hours for registered nurses. However, with an estimated $400,000 annual cost to comply with the staffing proposal, industry representatives are pushing for a longer implementation period due to low Medicaid rates and labor shortages.
On the other hand, critics argue that residents will suffer harm due to the long phase-in period. Moreover, there are concerns that a longer implementation timeline would further incentivize for-profit nursing home operators to transfer excessive profit away from increasing staffing by raising wages.
Various groups, experts, and organizations have differing recommendations for the implementation timeline, emphasizing the importance of balancing the need for improved staffing with financial considerations and the quality of care for nursing home residents.