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Why Nursing Homes Need a Minimum Staffing Standard

January 12, 2023

In April 2022, the Centers for Medicare & Medicaid Services (CMS) announced it was beginning the process of implementing a minimum staffing standard for nursing facilities.   This standard would require nursing homes to have enough staff to provide each resident with a minimum amount of direct care each day. Since the announcement, CMS has undertaken a study to determine the standard and intends to publish proposed rules in early 2023. When implemented, this standard will be the most significant increase in protections for nursing homes in decades.

Staffing nursing homes adequately has multiple benefits to residents. Numerous studies have found that there is a correlation between higher staffing levels and improved care quality. A 2001 CMS study found that nursing home residents require 4.1 hours per resident day (hprd) of direct nursing care to avoid being at an increased risk of harm.  The study found that every day residents need, at a minimum, .75 hours of care performed by an Registered Nurse, .55 hours of care performed by a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN), and the remaining 2.8 hours of care to be performed by a Certified Nursing Assistant (CNA). Any new federal staffing standard should separately mandate staffing hours for each nursing staff category, i.e., RN, LPN/LVN, CNA. A 2020 paper recommended a guide for determining adequate staffing that resulted in a proposal for six different minimum staffing standards based on PDPM resident acuity levels. 

Consumer Voice strongly supports the creation of a staffing standard that creates different minimum staffing baselines based on the acuity of nursing home residents. It is essential that this standard provide minimum staffing levels based on resident acuity and be broken down into nursing staff to resident ratios. A minimum staffing standard will save countless lives and result in better health outcomes for nursing home residents across the country.

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