A Kaiser Family Foundation analysis reveals that less than 20% of US nursing homes meet the proposed staffing standards, posing significant challenges. The Centers for Medicare & Medicaid Services (CMS) introduced these requirements, which include minimum daily care from registered nurses and nurse aides. The data highlights disparities between for-profit and non-profit nursing homes, and considerable variations among states. Compliance with the proposed standards is expected to be a daunting task due to ongoing staffing shortages, potentially costing $40 billion over a decade, with these expenses likely passed on to health plans and residents.
A recent analysis by the Kaiser Family Foundation (KFF) has shed light on the critical staffing challenges faced by nursing homes in the United States. The findings reveal that the vast majority of these facilities are currently falling short of the proposed staffing standards, indicating a pressing need for increased personnel.
In September, the Centers for Medicare & Medicaid Services (CMS) introduced a proposed rule outlining three key staffing requirements for nursing homes that participate in Medicare and Medicaid programs. These requirements include providing each resident with a minimum of 0.55 hours of daily care from a registered nurse (RN) and 2.45 hours of daily care from a nurse aide. Moreover, nursing homes must maintain an RN on-site 24 hours a day, seven days a week, and conduct enhanced facility assessments regarding staffing needs.
KFF’s analysis, based on Nursing Home Compare data from nearly 15,000 nursing facilities, found that only a mere 19 percent of these facilities would meet both of these proposed staffing standards. This highlights that a significant 81 percent of nursing homes would need to hire additional staff to achieve compliance. Furthermore, the data indicates that while 52 percent of nursing homes meet the RN hours per resident day requirements, only 28 percent meet the nurse aide requirement.
Interestingly, there are notable disparities between for-profit and government/non-profit nursing homes. For-profit facilities were found to be more likely to require additional RNs or nurse aides to meet both standards compared to their government and non-profit counterparts. Additionally, for-profit nursing homes were also more likely to fall short of the individual standards for RNs and nurse aides.
Geographically, the percentage of nursing homes meeting the proposed staffing standards varies significantly by state. For instance, in Louisiana, hardly any nursing homes would meet these requirements, while in Alaska, all facilities comply. In more than half of the states, less than 25 percent of nursing facilities meet both the RN and nurse aide requirements.
The variability among states can be attributed to several factors, including the proportion of for-profit facilities, the availability of RNs and nurse aides in the state, and state-specific regulations governing minimum staffing levels.
CMS has also sought input on the possibility of an additional requirement for nursing homes to maintain staffing levels of 3.48 hours per resident day. This could include 0.55 hours from RNs, 2.45 hours from nurse aides, and an additional 0.48 hours from any nursing staff.
Interestingly, the data reveals that the percentage of nursing homes meeting the 3.48 hours per day requirement is not significantly different from those meeting the alternative standard, with 18.9 percent meeting this alternative threshold.
CMS has additionally proposed a case mix adjustment that would raise staffing level requirements for facilities caring for residents with higher health or functional needs. If this adjustment were implemented, only a very small fraction of facilities, approximately 0.3 percent, would meet the RN and nurse aide hours requirements.
In light of these proposed staffing standards, nursing facilities are likely to face substantial challenges in achieving compliance, especially as staffing shortages continue to plague the industry. Meeting these standards will necessitate increased operational costs for recruiting and retaining additional staff.
It’s worth noting that CMS estimates the cost of compliance with these proposals to be around $40 billion over the ten years following the final rule’s implementation. These costs are likely to be passed on to both public and private health plans, as well as nursing home residents.