Nursing homes will be required to have minimum levels of front-line caregivers for the first time under a new requirement announced by the Biden administration Monday.
The final policy, unveiled by Vice President Harris, comes despite intense lobbying from the nursing home industry and opposition from bipartisan lawmakers, who argue a federal standard is unfeasible because of a nationwide staffing shortage made worse by the COVID-19 pandemic.
President Biden in his 2022 State of the Union address announced a slate of nursing home reforms and vowed staffing minimums would be among them. Advocates have been calling for such a requirement for more than two decades, arguing that residents are safer and have better care with more staff.
Much of the final policy matches what the administration proposed last September. All nursing homes that receive federal funding through Medicare and Medicaid will need to have a minimum number of hours that staff members spend with residents.
Current law only requires that nursing homes have “sufficient” staffing to meet the nursing needs of residents. The “sufficient” rule is too vague, experts and advocates have said, and facilities have not been held to a high enough standard.
Among other provisions, the final rule will also require facilities to have a registered nurse on staff 24 hours per day, seven days per week.
Nursing homes would also be required to provide residents with at least 0.55 hours of care from a registered nurse every day, as well as 2.45 hours of care from a nurse aide.
The combined three hours falls short of what a key federal study from 2001 found; at a minimum, it said facilities should provide 4.1 hours of direct care per resident per day to ensure they’re safe from falls and other harms.
But most U.S. nursing homes don’t meet that standard, and advocates said residents are generally sicker and need more care now than 20 years ago.
The requirements of the rule will be introduced in phases, with longer timeframes for rural communities. Limited, temporary exemptions will be available for both the 24/7 registered nurse requirement and the underlying staffing standards for nursing homes in workforce shortage areas that demonstrate a good faith effort to hire.
Advocates have been calling for such a requirement for more than two decades, arguing that residents are safer and have better care with more staff, but the industry had successfully resisted.
Then the coronavirus pandemic hit. More than 200,000 nursing home residents and staff died from the virus, exacerbating the existing concerns and forcing federal officials into action.
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