Pearl River The Biden administration issued a minimum staffing rule for nursing homes that receive Medicaid and Medicare. I have to quickly add: finally! Our union represents nursing home workers in Louisiana and Arkansas. In bargaining contracts for homes owned by private operators every effort to bargain minimum floors for nurses, LPNs, and CNAs, or certified nursing assistants, have always been stonewalled. Our union and our workers constantly raise the issue of short staffing and overwork, and the companies have been equally adamant that staffing levels for patients are a forbidden topic embedded in their sanctified management rights. The comment period is over the next sixty days, so one way or another, this will finally be an area where there is progress.
The nursing home industry took a beating during the pandemic, forcing this issue to be front and center. The homes were a Covid kill zone with over 200,000 residents and staff dying. Workers left the homes in droves because of risk and low pay in the homes, and increased demand elsewhere in the healthcare and service industries because of staff shortages. The estimates now are in the 200,000 range for workers needed in homes.
The kindest description of the new rules would be that finally they are setting “minimum” standards. Similar to the concept of minimum wages, minimum ratios for staffing are just that and certainly not adequate. The proposed levels are “0.55 hours of care from a registered nurse per resident a day, and 2.45 hours of care from a nurse aide per resident a day. A registered nurse would be required to be on-site at all times and nursing-home care assessments would be strengthened under the proposal.”
How does this measure up? As the Times’ reports, the nurse standard…
translates to one registered nurse for every 44 residents. But that is below what the average nursing home already provides, which is 0.66 hours per resident, a 1:36 ratio, federal records show. At least one registered nurse would have to be on duty at all times under the proposed plan — one of the biggest changes for the facilities, as they currently must have nurses for only eight consecutive hours each day. The proposed rule also calls for 2.45 nurse aide hours per resident per day, meaning a ratio of about one aide for every 10 residents. While the federal government sets no specific staffing requirements for nurse aides, the average home already provides 2.22 nurse aide hours a day, a ratio of about 1:11.
I need to immediately add, “so they say.” Absent any current requirement, these numbers are self-certified by the homes and the enforcement is lax to nonexistent. Real adherence to even these minimums will necessitate more hiring of aides and nurses, and, hopefully, real penalties for noncompliance, including that failing to adhere to these standards would make homes ineligible for receiving federal funds, which is essentially a death penalty for many.
Operators are squealing like stuck pigs. They whine about the shortages, but have not raised pay to prevent them, and, unsurprisingly, want the government to compensate them for the increased staffing. It’s hard to credit their arguments since they are pretending that they are already meeting the minimum standards, which underlines my earlier point that some of these numbers are fabricated, so they are hoisted on their own petard. Advocates don’t like the new standards, and we’re with them 1000%, because they are too low, but in reality, the government and the advocates must understand that without an increased reimbursement standard the numbers wouldn’t go much higher. Much of this also lies with the state legislatures, rather than Congress. The nursing home industry is a powerhouse, especially in the Southern states. Legislators may go on and on about how well the homes are taking care of grandma, but they are tightfisted in paying their share and are militant in attacking all parts of the remaining safety net to keep their red meat base happy.
It’s not perfect, but it’s a start, and finally having a minimum, employment, and, most importantly, care will improve from this point.