Kaiser Health News: Biden’s Promise of Better Nursing Home Care Will Require Many More Workers
[UPDATED at 10:25 a.m. ET]
The Biden administration has identified core impediments to better nursing home care in its proposed overhaul of the industry, but turning aspirations into reality will require a complex task: mandating adequate staffing levels for all homes without bankrupting those that can’t afford far higher labor costs.
Right: Lori Smetanka is the Executive Director of the National Consumer Voice for Quality Long-Term Care
President Joe Biden’s proposals for the nation’s 15,000 skilled nursing facilities — released in advance of his State of the Union address this past Tuesday night — would lead to the most substantial increase in federal nursing home regulation since Congress reformed the industry in 1987. The centerpiece of the effort is establishing minimum staffing levels for facilities. To date, the Centers for Medicare & Medicaid Services requires “adequate” staffing but specifically mandates only a skeleton crew of round-the-clock nursing coverage and one registered nurse who works at least eight hours each day.
CMS has rebuffed requests to mandate higher staffing levels in the past, saying each facility should “make thoughtful, informed staffing plans.” But multiple examinations — including a thorough CMS study in 2001 — have concluded staffing levels are frequently inadequate, particularly on nights and weekends. Studies have found that homes with higher staffing levels have fewer patient injuries. The 2001 study set a standard that many nursing homes currently don’t meet, saying optimal care required roughly one staffer for every seven short-stay patients — like those recovering from a hospital stay — and one staffer for every six long-stay residents.
“We would not be surprised to see that number [of staffers] be higher in a new study because we know the care needs for residents and acuity levels have actually increased over the last 20 years,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, which advocates for older people who get services in nursing homes, assisted living facilities, and at home.
Requiring adequate staffing levels won’t solve the problem many homes face in finding and retaining nurses and aides, a systemic issue made worse by the pandemic. And it’s likely that many facilities — particularly those with the largest share of Medicaid residents — would struggle to afford substantial increases in their workforces.
“Regulations and enforcement, even with the best intentions, just can’t change that math,” Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit aging service providers, said in a statement. Mark Parkinson, president and CEO of the American Health Care Association, the largest nursing-home lobbying group, said in a statement that “we cannot meet additional staffing requirements when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers.”
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