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The Heritage Law Center, LLC Blog

New Federal Minimum Staffing Requirements for Nursing Homes

POSTED ON: May 16, 2024

On April 22, 2024, the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), issued a new elder care rule about minimum staffing requirements for nursing homes. The goals of this rule are to support family caregivers, boost compensation and job quality for care workers, expand and improve care options, and improve the safety and quality of care in federally funded nursing homes. Requirements of the rule will be phased in over five years.

Every day over 1.2 million residents receive care in Medicare- and Medicaid-certified nursing homes. While preparing these rules, CMS considered more than 46,000 public comments from an array of stakeholders, including nursing home residents and their family members, workers, advocates, and the industry. Many of these comments made it clear that when there isn’t enough staff, residents don’t get the necessary care.

New Nurse Staffing Standards

Nursing homes participating in Medicare and Medicaid will be required to follow nurse staffing standards outlined below.

  • Nursing homes will need to provide residents with 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.
  • A registered nurse must be on-site 24 hours a day, 7 days per week.

The above changes will go into effect in 2 years for urban nursing home and 3 years for rural nursing homes. Right now, fewer than 1 in 5 nursing facilities meet these nursing standards.

  • Nursing homes will need to do a more thorough staffing assessment to better identify resources and supports needed to properly care for the residents and then implement plans to attain those goals. Nursing facility staff and residents’ families or their legal representatives will contribute to the assessment. The first phase of this new rule will be audits that will take effect 60 days after publication of the final rule.
  • Create a staffing plan to maximize recruitment and retention.

Per Kaiser Family Foundation, 90 percent of for-profit facilities will need to hire more nursing staff and 60 percent of nonprofit and governmental facilities will need more nursing staff. The goal of this effort is to improve resident safety and provide a higher quality of care to the residents.

CMS’ Responsibilities

  • Expand audits of the direct care staffing data nursing homes must report. Goal is to have accurate information online at Nursing Home Care Compare and CMS’ website for families and prospective residents to use to learn about the nursing homes.
  • Evaluate state inspection findings to make sure any deficiencies receive an appropriate consequence.
  • Ensure taxpayer dollars are being used for safe, high-quality care. One way this will be accomplished is that Medicaid agencies will be required to report on the percent of Medicaid payments for institutional long-term services and supports (LTSS) that go toward the compensation for direct care workers and support staff.
  • Improve resident safety when faced with emergencies. One effort to meet this objective will be conducting a national study of how prepared nursing homes are for emergencies, which will also define what the key challenges are and identify how to strengthen protections for residents.

Will It Be Difficult for Nursing Homes to Meet these Terms?

According to a Kaiser Family Foundation study, nursing home administrators point to a shortage of registered nurses and aides as being an obstacle to achieving the goals of the rule. In an effort to overcome that hurdle, CMS’s plan includes spending $75 million to incentivize nurses to work in nursing homes by using scholarships and tuition reimbursement.

Planning for Long-Term Care

Long-term care is one of the largest expenses many seniors face. In the Boston area, nursing home costs average around $14,000 per month. As costs continue to rise, many families remain unable to figure out how to pay for these services. MassHealth for long-term care will cover the cost of long-term care in a nursing home for financially limited Massachusetts seniors who require nursing facility level care.

As an experienced MassHealth attorney, I can help you understand MassHealth and discuss how we can assist you in maximizing your legal strategies to protect your assets. We can also help you through the burdensome and often confusing application process for MassHealth benefits for long-term care. Contact us today to schedule a consultation.