US will regulate nursing home staffing for first time, but proposal lower than many advocates hoped

Most U.S. facilities don’t meet that threshold. Many advocates said even it was insufficient, not taking into account quality of life, simply determining the point at which residents could suffer potential harm.

After the Democratic president elevated the issue in his State of the Union speech, advocates were initially elated, expecting the most significant change for residents since the Nursing Home Reform Act of 1987. That changed after a copy of a new CMS-funded study on the subject was inadvertently posted this week, claiming there is “no obvious plateau at which quality and safety are maximized.”

Advocates were bereft, saying they felt betrayed by administration officials they thought to be allies. As word of the proposal became public early Friday some were even more blistering.

Richard Mollot, who leads the Long Term Care Community Coalition, called it “completely inadequate” and a blown chance of “a once-in-a-generation opportunity” that “flouts any evidence” of what residents need and fails to make good on the heart of Biden’s promise. He begrudgingly acknowledged the 24/7 RN rule could bring small improvements to the worst facilities, but he otherwise was withering in his criticism.

Calling the move “heartbreaking” and “nauseating,” he said it would do more harm than good, putting a government imprimatur on poorly staffed homes and imperiling wrongful-death lawsuits.

“It is a tremendous dereliction of duty,” he said. “We are continuing to allow nursing homes to warehouse people and to rip the public off.”

Current law requires only that homes have “sufficient” staffing, but it leaves nearly all interpretation to states. Thirty-eight states and the District of Columbia have their own staffing regulations. Some are so low that advocates say they’re meaningless, and, across the board, enforcement is often toothless.

The problem has long been apparent to front-line nurse aides — the low-paid, overwhelmingly female and disproportionately minority backbone of facility staffs — and to residents themselves, whose call bells go unanswered, whose showers become less frequent and who lie hungry, awaiting help with meals.

The coronavirus pandemic, which claimed more than 167,000 U.S. nursing home residents, brought the greatest attention to poor staffing in history. But, in its wake, many homes saw their staffing grow even thinner.

Across all job types, Bureau of Labor Statistics data shows nursing homes have 218,200 fewer employees than in February 2020, when the first U.S. outbreak of the coronavirus arrived at a nursing home outside Seattle.

AHCA has waged a relentless campaign claiming facilities were teetering, with Medicaid subsidies insufficient, widespread hiring issues and rampant home closures. While there have been scattered closures, the profitability of homes has repeatedly been exposed and critics have argued, if they just paid better, the workers would come.

Katie Smith Sloan, the head of LeadingAge, which represents nonprofit nursing homes, said it was meaningless to create a rule requiring facilities to hire additional staff when the industry was already in a workforce crisis and “there are simply no people to hire.”

“To say that we are disappointed that President Biden chose to move forward with the proposed staffing ratios despite clear evidence against them is an understatement,” she said.