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Comment on the Proposed Minimum Staffing Standard in Nursing Homes

On September 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited Notice of Proposed Rulemaking (NPRM) proposing a minimum staffing standard in nursing homes. Consumer Voice believes the proposed staffing standard does not go far enough to protect residents of nursing homes. Read Consumer Voice's statement on the proposed rule.

Organizations: Use our template comment letter.

How to Comment & Talking Points to Include

To comment: 

1.) Open the commenting webpage in a new tab:  https://www.regulations.gov/commenton/CMS-2023-0144-0001

2.) In the comment box, state that:

The proposed rule does not go far enough to protect nursing home residents from harm.

Share your personal story or experience about the impact of inadequate staffing on you or someone you love.   

3.) Use these suggested talking points (feel free to copy/paste): 

In order to protect nursing home residents from harm and to ensure a high quality of life: 

  • Require nursing homes to meet a total staffing standard of 4.2 hours per resident day (HPRD) within the next two years. This total should be made up of at least:
    • 1.4 HPRD of total licensed nurse care, composed of at least .75 HPRD of registered nurse (RN) care; and
    • 2.80 HPRD of certified nurse aide care (CNA).

RNs, LPNs/LVNs, and CNAs each have important roles in the provision of quality care to residents. A staffing standard should address total direct care for residents. These staffing levels are supported by decades of research and by the 2023 Staffing Study commissioned by CMS last year.

These additional requirements are financially feasible because the costs would be less than five percent of the over $100 billion that nursing homes receive from Medicare and Medicaid annually.

  • No waivers to facilities that cannot provide a level of care that ensures resident safety.
  • Restrict admissions when minimum staffing standards are not met.
  • Reduce the timeframes for implementation, particularly in rural areas, and require phased-in compliance. The 2023 Staffing Study found that staffing in rural homes is almost identical to staffing in homes located in urban areas. Residents in rural homes should not suffer for years before the staffing standard is implemented.

4.) In the drop-down question, “What is Your Comment About?” identify yourself from the choices.

5.) Complete the remaining questions on the form 

6.) Click, “Submit Comment.” 

All comments are due by November 6, 2023.

We strongly urge you to  encourage others to comment. It is vital that CMS hears from as many people as possible that this rule needs to be strengthened!

Thank you for making your voice heard!