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CMS Must Make the Minimum Staffing Rule Stronger To Protect All Nursing Home Residents

September 22, 2023

Nursing home residents, their families, and advocates have advocated for a minimum staffing standard for decades. In February 2022, President Biden announced an historic set of nursing home reforms, intended to improve quality and safety, including a minimum staffing standard,

On September 6, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a Notice of Proposed Rule Making (NPRM) that would implement a minimum staffing standard. While Consumer Voice appreciates that a standard has been proposed, it must be made much stronger so that ALL nursing home residents are safe and living a high quality of life. Consumer Voice recommends:

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

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.
  • Not delaying implementation of this standard for five years in rural areas. 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.

Consumer Voice strongly supports CMS’ proposal to require nursing homes to have an RN on staff 24 hours per day, seven days per week. RNs play a critical role in resident care. The current requirement of eight hours per day places all residents at risk of harm.

Consumer Voice also supports the proposed Medicaid transparency provisions, although we also request that Medicaid cost reports be made publicly available to disclose the total amount of spending on nursing, ancillary, and support services compared with spending on administration, property, and profits. Medicare costs reports also should be made more transparent regarding spending, related party transactions, and disallowances, along with greater accountability requirements for ensuring that funds are spent on resident care.

Consumer Voice supports the proposed enhancements to the facility assessment requirements. These new provisions would require facilities to develop and implement staffing plans that are based on residents’ needs and acuity. These plans would also include staff retention and hiring plans. For these provisions to be effective, however, it will be critical that they are enforced by state regulators. 

Consumer Voice will work with residents, families, and other advocacy organizations to submit comments that urge CMS to adopt a strong standard for all nursing home residents. Please stay tuned for more information.

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