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Nursing home staffing is a critical component of resident care and safety. Recent federal mandates have underscored the importance of adequate staff in these facilities, particularly in light of the challenges faced during the pandemic.

The pandemic exposed the vulnerabilities within nursing homes, revealing the devastating consequences of understaffing. Inadequate staffing levels contributed to the spread of infections and compromised resident care. The need for sufficient staff to provide quality care and ensure resident safety has never been more evident.

Key Points of the Mandate

According to a fact sheet published by the White House, “The Nursing Home Minimum Staffing Rule finalized today will require all nursing homes that receive federal funding through Medicare and Medicaid to have 3.48 hours per resident per day of total staffing, including a defined number from both registered nurses (0.55 hours per resident per day) and nurse aides (2.45 per resident per day). This means a facility with 100 residents would need at least two or three RNs and at least ten or eleven nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the minimum staffing standards. Many facilities would need to staff at a higher level based on their residents’ needs. It will also require facilities to have a registered nurse onsite 24 hours a day, seven days a week, to provide skilled nursing care, which will further improve nursing home safety. Adequate staffing is proven to be one of the measures most strongly associated with safety and good care outcomes.”

The fact sheet also stated, “To make sure nursing homes have the time they need to hire necessary staff, the requirements of this rule will be introduced in phases, with longer timeframes for rural communities. Limited, temporary exemptions will be available for both the 24/7 registered nurse requirement and the underlying staffing standards for nursing homes in workforce shortage areas that demonstrate a good faith effort to hire.”

Industry Opinions

Some experts raise concerns about the feasibility of meeting the mandated requirements, citing the ongoing challenges of staffing shortages within the industry. According to Skilled Nursing News, “Katie Smith Sloan, president and CEO of LeadingAge, criticized the rule for not including any support for recruitment and training of needed staff. “How can providers hire more RNs when they do not exist?” she said in a statement. “Nurse aides, who are the backbone of aging services, are also in short supply – yet again, the rule does not include support to recruit, train and hire more of these critical workers. By the Centers for Medicare and Medicaid Services’ (CMS) estimate, the rule will add to providers’ financial burden – by $43 billion, over 10 years.”

To address these concerns, the rule will be implemented gradually, allowing nursing homes time to hire additional staff and adjust to the new requirements. This phased approach aims to minimize disruptions to resident care while ensuring compliance with the mandate.

Particular attention will be paid to the challenges faced by rural communities, where recruiting and retaining staff may be more challenging.

The new nursing home staffing mandate represents a pivotal moment in prioritizing resident care and safety. By establishing minimum staffing ratios and requiring 24/7 RN coverage, the mandate aims to address longstanding challenges within the industry. While concerns about staffing shortages persist, the potential positive impact on residents’ well-being cannot be overstated.

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