Transformation in Nursing Home Care: HHS Proposes New Staffing Standards
Thursday, September 7, 2023
New staffing requirements for nursing homes

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has issued a proposed rule aimed at establishing comprehensive staffing requirements for nursing homes. This proposal includes the introduction of national minimum nurse staffing standards, for the 1.2 million residents living in nursing homes in the United States.

The proposed rule would mandate that nursing homes participating in Medicare and Medicaid meet specific nurse staffing levels. This would require a minimum of 0.55 hours of care from a registered nurse per resident per day and 2.45 hours of care from a nurse aide per resident per day, surpassing existing standards in most states. It is estimated that around 75% of nursing homes would need to enhance their staffing levels. To account for local variations, the proposal includes staggered implementation and exemptions for rural and underserved communities.

Furthermore, nursing homes would be required to have a registered nurse present 24/7 and conduct thorough facility assessments to determine staffing needs tailored to individual residents. States would also be obligated to collect and report on worker compensation as a percentage of Medicaid payments for those employed in nursing homes.

The proposal is driven by the understanding that insufficient staffing in nursing homes can lead to compromised resident safety and lower care quality. Inadequate staffing can result in residents being unable to perform basic daily tasks, such as bathing, dressing, and maintaining hygiene. Improving working conditions and wages for direct care workers is expected to enhance recruitment and retention and ultimately lead to safer care for residents.

Overall, the proposed rule and related initiatives reflect the commitment to reforming the long-term care system to provide dignified aging for older Americans, high-quality services for people with disabilities, and better support for family caregivers, while also improving the working conditions and wages of direct care workers. Of course, there is significant industry pushback citing cost concerns.  


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