The federal government's new staffing requirements for nursing homes present a formidable challenge for facilities nationwide. These requirements mandate significantly higher staffing levels, aiming to improve nursing homes' overall work environment and care quality. However, meeting these new standards is proving to be a daunting task.
Nationwide Shortfall
An analysis of the most recent payroll-based journal (PBJ) data reveals a grim reality: if the new staffing requirements were enforced today, most nursing homes in the U.S. would fall short. As of the summer quarter of 2023, only 160 out of 14,500 facilities (approximately 1%) would meet the new requirements. This highlights the scale of the challenge ahead for nursing homes across the country.
Industry Response
Scott Heichel, Director of Clinical Reimbursement at LeaderStat, a national healthcare recruitment and consulting firm, acknowledged the good intentions behind the federal mandate. The aim is to raise minimum staffing levels and improve the work environment for nursing home administrator careers. However, Heichel emphasized that it is an uphill battle to recruit enough nursing home administrators for clinical roles in nursing homes.
Significant Costs
The financial implications of meeting the new staffing requirements are substantial. The American Health Care Association (AHCA) estimates the requirements will cost $6.5 billion annually. These costs include hiring, training, and retaining additional staff, which significantly burdens many facilities. The AHCA also estimates that 102,000 clinicians will be needed to meet the new staffing mandate.
Lack of Financial Support
Despite these costs, the Centers for Medicare & Medicaid Services (CMS) is not providing direct financial support to cover these expenses. CMS has allocated $75 million for scholarships and tuition reimbursement programs to help grow the workforce. However, Heichel noted that there is no guarantee that graduates will choose to work in nursing homes over other healthcare settings. Convincing people to work in nursing homes remains a tough job, and with agency work, the staffing mandate may achieve its thresholds.
Increasing the Workforce
Heichel highlighted the challenge of convincing 102,000 new clinicians to join the nursing home workforce. At the webinar titled "What Skilled Nursing Facilities Should Know About the Final Nursing Home Minimum Staffing Rule," he stressed the importance of reducing burnout and turnover by increasing staff numbers. However, without a significant shift in strategy to increase the size of the nursing home workforce, the staffing rule may lead to more deployment of agency staff.
Facility Assessments and Compliance
A crucial aspect of the new regulations is the facility assessments. Each nursing home must evaluate its specific needs and determine appropriate staffing levels based on the acuity and needs of its residents. This assessment must be evidence-based and data-driven, utilizing tools such as the Minimum Data Set (MDS) and other quality measures. The facility assessment also informs contingency plans for non-emergency events, ensuring consistent care under various conditions. This process becomes enforceable on August 8, 2024.
Criteria and Challenges
CMS offers exemptions and waivers for facilities that struggle to meet nursing home administrator career and staffing requirements. These are intended for nursing homes that can demonstrate a genuine effort to recruit staff but are unsuccessful due to local workforce shortages. To qualify, the facility must be in an area where the ratio of relevant healthcare staff to the population is at least 20% below the national average. Facilities seeking an exemption must prove their efforts through documented job postings, recruitment and retention plans, and financial commitments to staffing. However, obtaining an exemption is complex and requires detailed evidence and renewal at each standard recertification survey.
Public Perception
Exemptions also mean it is public knowledge that a facility is exempt from the staffing requirements. This could create image issues for the nursing home and potentially divert residents away, further complicating the situation.
Reducing Reliance on Agency Staff
Heichel emphasized the need to reduce reliance on agency staff and instead employ a stable, dedicated team. This approach is seen as a better solution, but it will be challenging in the current labor market. "If it were that easy, we would already have the staffing. We would not have buildings struggling with staffing right now," he said. Even though facilities still need to meet the minimum staffing requirement, many are already working short or utilizing agency staff to fill gaps.
Final Rule Mandates
The final rule mandates a minimum of 3.48 hours per resident per day (HPRD) of total staffing, with specific allocations for registered nurses (RNs) and nurse aides. This includes 0.55 HPRD of direct RN care and 2.45 HPRD of direct nurse aide care. Facilities can use a mix of nurse staff, including RNs, LPNs/LVNs, or nurse aides, to meet the additional 0.48 HPRD.
Conclusion
The new federal staffing requirements for nursing homes present a significant challenge, necessitating substantial investment and strategic changes. As facilities navigate these new regulations, the focus must be on developing robust recruitment and retention strategies, utilizing practical facility assessments, and applying for exemptions and waivers where necessary. The goal is to ensure staffing nursing home administrator careers comply with federal requirements and are sufficient to provide high-quality care tailored to the specific needs of residents. The upcoming months will be critical as nursing homes adjust to these changes, striving to balance compliance with financial and workforce constraints.
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