CMS finalizes minimum staffing standards for nursing homes
The Centers for Medicare & Medicaid Services April 22 finalized minimum staffing requirements for nursing homes that participate in Medicare and Medicaid. As proposed in September, the final rule will require nursing homes to provide a minimum of 3.48 hours of nursing care per resident day, including 0.55 hours of care from a registered nurse per resident day and at least 2.45 hours of care from a nurse aide per resident day, as well as 24/7 onsite RN services. CMS slightly expanded the opportunity for facilities to seek exemptions from the requirements from its original proposal. AHA had urged CMS not to finalize the proposal but instead develop more patient- and workforce-centered approaches focused on ensuring a continual process of safe staffing in nursing facilities.
In a statement, Stacey Hughes, AHA executive vice president, said, "The AHA strongly believes that a skilled, caring workforce is integral to delivery of high quality, safe care. Yet, the process of safely staffing any health care 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 nursing homes 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.
"This final rule could lead nursing homes to reduce capacity or close outright, including those that are otherwise high performers on quality and safety metrics. The loss of these nursing home beds could adversely impact patients who have completed their hospital treatment and need continuing care in nursing facilities. The AHA has already documented rising lengths of stay for hospital patients in need of skilled post-acute care, with patients waiting days, weeks or even months for post-acute care placements. As those patients continue to occupy hospital beds, other patients awaiting elective surgeries or other scheduled procedures may find their care disrupted because there is no bed for them in the hospital. Even more troubling, this final rule could lead to delays in urgent medical care as patients coming into hospital emergency departments may experience longer waits as EDs and inpatient beds are occupied by patients awaiting nursing home placements.
"Lastly, this final rule could exacerbate the already serious shortages of nurses and skilled health care workers across the care continuum. Strengthening the health care workforce requires investment and innovation, not inflexible mandates. The AHA will continue to work with Congress and the Administration to advance sustainable approaches to bolstering the health care workforce and delivering high quality, safe, and accessible care."