NEW YORK (AP) – The federal government will, for the first time, dictate staffing levels at nursing homes, the Biden administration said Friday, responding to systemic problems posed by massive COVID-19 deaths.
While such regulation has been sought for decades by older adults and allies of people with disabilities, the proposed limits are far lower than many advocates expect. This immediately drew the ire of the nursing home industry, which said it was an order that could not be met.
With criticism expected, details of a promised fanfare in President Joe Biden’s 2022 State of the Union speech emerged as many Americans turned their backs on the news for the holiday weekend.
“Establishing minimum staffing standards for nursing homes will improve the safety of residents,” Health Secretary Javier Becerra said in a statement. “When facilities are short-staffed, residents suffer.”
The American Health Care Association, which lobbies for care facilities, called the proposal “unfathomable”, saying it would worsen existing problems and cost homes billions of dollars.
Mark Parkinson, former Democratic governor of Kansas, president of the AHCA, said, “We hope to convince the administration to never finalize this rule because it is unfounded, unfunded and unrealistic.”
The proposed rules, which are now entering the public comment period and will take several years to fully take effect, call for the equivalent of 3 hours of staffing per resident per day, requiring just over half an hour from registered nurses. Is. The rules also state that an RN must be on staff 24 hours a day.
According to government reports, the average US nursing home is already staffed for about 3.6 hours of caregiving per resident per day, with RN staffing slightly above the half-hour mark.
Still, the government insists that most of the country’s roughly 15,000 nursing homes, which house some 1.2 million people, would have to add staff under the proposed rules.
Chiquita Brooks-LaSure, head of the Centers for Medicare and Medicaid Services, or CMS, called the move “an important first step.” CMS oversees the nursing home.
A senior White House official said on condition of anonymity before the announcement that the Biden administration is open to revisiting the staffing limit once it is implemented.
“I would caution anyone who thinks that the status quo — which has no federal standards for nursing home staffing — is preferable to the standards we’ve proposed,” said Stacey Sanders, Becerra’s aide. “This standard will increase staffing levels for nursing homes by more than 75%, bring more nurse aides closer to the bedside and ensure that every nursing home has a registered nurse on site 24/7.”
The new limits are far less than the limits longtime advocates had eyed after a landmark 2001 CMS-funded study recommended an average of 4.1 hours of nursing care per resident per day.
Most US facilities do not meet that limit. Many advocates said that even this was insufficient, taking quality of life into account, only determining the point at which residents could be potentially harmed.
Advocates were initially excited after the Democratic president raised the issue in his State of the Union speech, expecting the most significant change for residents since the Nursing Home Reform Act of 1987. That changed after a copy of a new study funded by CMS. The topic was inadvertently posted this week, claiming that “there is no clear plateau at which quality and security are maximized.”
The advocates were dismayed, saying that they had been betrayed by administrative officials whom they considered allies. As news of the proposal became public early Friday, some were even more acrimonious.
Richard Molot, who leads the Long-Term Care Community Coalition, called it “grossly inadequate” and a blown opportunity of a “once-in-a-generation opportunity” without “any evidence” of what residents need. ignores” and fails to complete it. The heart of Biden’s promise. He reluctantly acknowledged that the 24/7 RN rule might bring about small improvements in the worst facilities, but was otherwise subdued in his criticism.
Describing the move as “heart-wrenching” and “vomit-causing”, he said it would do more harm than good, impose government seals on poorly staffed homes, and risk wrongful-death lawsuits.
“This is blatant dereliction of duty,” he said. “We are continuing to allow nursing homes to warehouse people and rob the public.”
Current law only requires that homes have an “adequate” staff, but leaves almost all interpretation up to the states. Thirty-eight states and the District of Columbia have their own staffing regulations. Some are so low-level that advocates say they are meaningless, and, across the board, enforcement is often toothless.
The problem has long been apparent to frontline nurse aides — the low-paid, overwhelmingly female and disproportionately minority backbone of the facility staff — and to the residents themselves, whose call bells go unanswered, whose showers are scant. Goes and helps those who are hungry while waiting with food.
The coronavirus pandemic, which has killed more than 167,000 US nursing home residents, has drawn some of the most attention in history to poor staffing. But, in its wake, the number of employees in many households reduced even further.
Across all job types, data from the Bureau of Labor Statistics show nursing homes have 218,200 fewer workers than in February 2020, when the first outbreak of the coronavirus in the US reached a nursing home outside Seattle.
The AHCA has run a relentless campaign claiming that facilities are understaffed, Medicaid subsidies are inadequate, there are rampant recruiting issues and massive home closures. But there has been no sign of widespread closures, the profitability of the houses has been repeatedly exposed and critics have argued, if they are paid better, workers will come.
Katie Smith Sloan, principal at LeadingEdge, which represents nonprofit nursing homes, said creating a rule requiring facilities to hire additional staff was pointless when the industry was already in a workforce crisis and “need to hire.” There are no people for it.”
“To say that we are disappointed that President Biden decided to move forward despite the clear evidence against the proposed staffing ratio is an understatement,” he added.
This story has been corrected to reflect that the leader of the Long Term Care Community Coalition is surnamed Molot, not Molot, and that the health secretary’s surname is Becerra, not Becerra, in another reference.
Matt Cedensky, The Associated Press