On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued Minimum Staffing Standards for Long-Term Care Facilities, to provide safe and high-quality care for residents living in Medicare- and Medicaid-certified facilities. 

“There are approximately 1.2 million Americans who are living in federally funded nursing homes. That’s about four out of five of the nursing homes in our country. So, the vast majority of nursing homes are federally funded,” said Vice President Kamala Harris at a roundtable discussion on April 24 on nursing home care.

“And the majority of federally funded nursing homes are understaffed. The estimate is 75 percent of those nursing homes are understaffed. And understand what that means for the resident of that nursing home. 

“It means that there may be no one available to help them out of bed. It means there may be no one available when they fall. It means that they will receive less medical attention because the workers — the care workers in that facility are going from room to room, from resident to resident, and understaffed in terms of giving folks what they want to give in terms of level of care. 

“It means more loneliness when we’re talking about anyone from our seniors to people with disabilities who are in those homes and who want and enjoy the interactions that they have with these care workers. …

“This is God’s work, to care for people who often you’ve never met before, they’re not related to you, and you care for them as though they’re a member of your family.”

— Vice President Kamala Harris

“For residents, this will mean more staff, which means fewer ER visits. potentially, more independence for families. It’s going to mean peace of mind in terms of your loved one being taken care of. And for care workers, it’s going to be more time with their patients, less burnout, and lower turnover.”

AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond issued the following statement in response to the Centers for Medicare & Medicaid Services final rule that requires America's nursing homes to have enough staff to provide the high-quality care that residents expect and need. 

“For years, AARP has fought to ensure the health and safety of every person living in a nursing home. CMS’s long overdue rule to require minimum staffing levels in America’s nursing homes will help protect the basic rights of residents to live in dignity. It is shameful that nursing homes receiving taxpayer dollars through Medicaid and Medicare haven’t been required to provide quality care through specific minimum staffing standards until now. Far too many residents and families have experienced tragic consequences because of poorly staffed facilities. AARP commends CMS for requiring nursing homes to meet important staffing standards, including having a registered nurse on site 24 hours a day, 7 days a week.   

“Ultimately, ensuring nursing homes are adequately staffed will improve the quality of care residents receive and can give family caregivers peace of mind, knowing their loved ones are living with the quality of life they deserve,” LeaMond said.

Harris also addressed a new requirement to help increase pay for home healthcare workers. 

Medicaid currently pays $125 billion a year to home healthcare companies. But home care companies have not been required to report how their federal dollars were being spent.

New rules will require that 80 percent of that money be spent on paying workers as opposed to administrative overhead costs. 

“This is about dignity,” Harris said. “This is God’s work, to care for people who often you’ve never met before, they’re not related to you, and you care for them as though they’re a member of your family. … Let’s recognize the gift that these talented professionals give to families and to all of us as a society.”

This final rule was informed by the feedback CMS received from over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within LTC facilities. 

Additionally, to increase transparency related to compensation for workers, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

Some LTC facilities may still be experiencing challenges in hiring and retaining certain nursing staff because of local workforce unavailability. Therefore, in addition to the existing statutory waiver of requirement to provide licensed nurses on a 24-hour basis, CMS is finalizing our proposal for hardship exemptions to apply in limited circumstances to the hours per resident day  and 24/7 onsite RN requirements.

Nursing Home Staffing Campaign

The Virginia Health Care Association – Virginia Center for Assisted Living, representing over 350 long term care providers in Virginia, released results last October of a workforce survey of nursing home and assisted living facilities across the Commonwealth. Results from the survey showed the on-going struggle facing these providers as they work to find more caregivers for residents and patients. Nearly half (44%) of nursing homes have had to limit their admissions for lack of staff. Facilities are struggling to find new caregivers, despite significant hiring efforts. The survey and summary came before the issue of the new staffing standards. 

The survey showed that 91% of facilities had CNA vacancies; 81% had LPN vacancies; 64% have RN vacancies; 31% had few to no applicants for vacant positions.

In September 2023, Centers for Medicare & Medicaid Services said that the agency would spend over $75 million to launch a national nursing home staffing campaign to increase the number of nurses in nursing homes. Through this campaign, CMS will be providing financial incentives for nurses to work in the nursing home environment. For example, nurses could receive tuition reimbursement for a specific commitment to work in a qualifying nursing home or in an oversight capacity with a state inspection agency. It will also be easier for individuals to become nurse aides by streamlining the process for enrolling in training programs and finding placement in a nursing home. CMS will be using the campaign to promote awareness of the many career pathways in the nursing field that are available to help recruit all types of individuals, from NAs to LPNs/LVNs and RNs. To help accomplish these tasks, CMS will launch an awareness campaign for these programs and the benefits of working in nursing homes.

Additionally, CMS will partner with states to bolster nurse recruitment. For example, states will be able to invest funds to improve their nurse aide training information and increase the number of financial incentives available. Financial incentives could begin to be distributed in 2025. These incentives will supplement nursing homes’ efforts to increase staffing. 

The final rule is available to review today in the Federal Register at: https://www.federalregister.gov/public-inspection/2024-08273/medicare-and-medicaid-programs-minimum-staffing-standards-for-long-term-care-facilities-and-medicaid