If there’s one thing nursing home providers, consumer advocates and regulators can all agree on when it comes to the development of a federal minimum staffing rule, it might be just how difficult the job will be.
The Centers for Medicare & Medicaid Services has given itself until next March to study the issue of staffing — the types and levels needed — and propose a new rule mandating coverage. It’s part of a sweeping Biden administration initiative to reform nursing home care on the heels of COVID-19’s devastating impact.
The federal government has been grappling with the relationship between staffing coverage and patients outcomes for more than 20 years, commissioning prior studies and failing to update standards as part of other, broader healthcare initiatives.
The release of a proposed 2023 pay rule Monday afternoon reiterated agency leaders’ earlier comments that, this time, CMS intends to deliver. Staffing-related provisions include a new value-based incentive element for total nurse staffing and an official requesting comment on the coming direct care staffing requirements.
CMS, however, has much to consider in a yearlong study leading up to the proposed staffing minimum expected early next spring. The agency Monday asked stakeholders to comment on at least 17 related issues. They range from how to calculate the measure to who to include and how to account for labor challenges to how much the requirement will cost — and if better outcomes, such as lower hospitalization rates, might provide an offset.
“It’s obviously very important that we have standards of care and that facilities should be meeting those standards,” Ashvin Gandhi, Ph.D., a UCLA health economist who studies staffing and turnover, told McKnight’s Long-Term Care News. “CMS does have to think really carefully about whether and to what degree facilities are going to be able to financially meet staffing requirements. You could have unintentional consequences.”
But increased labor costs and shortages seem unlikely to slow the CMS effort. If anything, the agency’s efforts were bolstered by the April release of a long-awaited National Academies report on nursing home care, which also called for major workforce changes.
“It seems like now is the moment,” Steven Littlehale, gerontological nurse specialist and data analyst with Zimmet Health Care Services Group, said during a recent McKnight’s podcast. “It seems like the planets are aligning in that we may actually see real, authentic minimum staffing requirements that go beyond the hard-to-define terms such as ‘sufficient’ staffing.”
History at work
The basis for today’s staffing rules date back to the 1987 Nursing Home Reform Act, which called for 24-hour LPN coverage and eight hours of RN coverage each day. The …….