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CMS Releases Proposed Rule on Nursing Homes Minimum Staffing Standard

September 01, 2023

Today, the Centers for Medicare & Medicaid Services (CMS) released the long-anticipated Notice of Proposed Rule Making (NPRM) that would implement a minimum staffing standard in nursing homes. While Consumer Voice is continuing to review the NPRM, we are extremely disappointed with CMS’s proposal. The proposal flies in the face of decades of research demonstrating a need for a strong staffing standard that protects all nursing home residents from harm.

Key highlights from the rule include:

  • Nursing homes would be required to provide only 3 hours of direct care per resident per day. This requirement would include only .55 hours of Registered Nurse (RN) care and 2.45 hours of certified nurse aide (CNA) care. The NPRM failed to propose a minimum for licensed practical nurses (LPNs) who play a critical role in nursing home care.
  • Facilities would be eligible for waivers from complying with this minimum if they met certain criteria.
  • Implementation of the requirement would be phased in over a 3-year period.
  • Facilities would be required to have an RN on staff 24 hours a day, 7 days a week. This requirement would be an increase from the current requirement of eight hours per day.

Over twenty-years ago an in-depth, evidenced-based CMS study found that each nursing home resident required at least 4.1 hours of direct care each day to avoid compromised care that placed residents at risk of harm. Today, nursing home residents are sicker, as many more functional older individuals choose to remain at home and live independently. Rather than taking steps to ensure all residents receive high quality care, today’s proposed rule would implement a standard of care well below the 4.1 hours of care and result in an increased risk of harm to nursing home residents.

Despite this dismal proposal, it is critical that we all comment on this rule to make it better. There is ample evidence supporting staffing standards significantly higher than the rule proposed by CMS. CMS, Congress, and other policy makers  need to hear our voices to make this proposal better.

We are continuing to review the rule and will be holding a webinar in the coming weeks to discuss the rule and how to comment. Please stay tuned for more information.

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