Nurse Staffing Estimates in US Nursing Homes May 2024
A new brief from the U.S. Department of Health and Human Service Office of the Assistant Secretary for Planning and Evaluation (ASPE) uses Nursing Home Care Compare Data from May 2024 to examine current staffing levels in US nursing homes, relative to specific minimum staffing requirements in the final rule.
The Centers for Medicare & Medicaid Services (CMS) issued the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting final rule establishing new minimum requirements for nurse staffing levels in nursing homes in April. The final rule requires a total nurse minimum staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide (NA) care. Facilities may use any combination of nurse staff (RN, NA, licensed practical nurse [LPN] or licensed vocational nurse [LVN]) to account for the additional 0.48 HPRD needed to comply with the total nurse minimum staffing standard. In addition, the rule also requires nursing homes to have an RN onsite 24 hours a day, 7 days a week, to provide skilled nursing care.
Here are some highlights of the brief
- 78 percent of nursing homes already provide at least 24 hours of RN care per day
- The most significant gaps in nursing home staffing are for nurse aides with 70 percent of facilities staffing below the minimum
- The final rule allows between 3 and 5 years for facilities to recruit these additional staff, and also allows for temporary hardship exemptions to the HPRD and 24/7 onsite RN requirements depending on a facility’s location and local supply of nurse staff, the facility’s good faith efforts to add and retain staff and demonstrated financial commitment to staffing.
- Non-profit facilities were more likely than for-profit facilities to staff at or above each of the HPRD minimum requirements and were more likely to provide 24 RN hours per day.
- Certain types of for-profit nursing home ownership arrangements – particularly
private equity (PE) and real estate investment trust (REIT) ownership – can divert resources from staffing and direct resident care resulting in worse quality. This analysis and other studies referenced highlight opportunities for for-profit nursing homes to enhance safety and quality of care through greater investments in staffing.
Check out the full brief here.
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Myth vs Fact
Despite adjustments to the final rule and the generous timeline for compliance–not to mention the fact that it will improve the quality of jobs for nursing home workers and the safety of care for residents–nursing home industry organizations are attempting to overturn it through a Congressional Review Act resolution, other legislation, and legal action. This fact sheet responds to key claims the industry has raised as it attempts to roll back the rule.
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Researchers Find That Minimum Staffing Rule Will Save 13,000 Lives Annually
A new analysis by researchers at the University of Pennsylvania shows that the recently finalized minimum staffing rule would save 13,000 lives annually. Senator Elizabeth Warren announced the findings in a press statement. The analysis estimated lives saved by state. In KY it is estimated to save 101-250 lives!
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Keep the Minimum Staffing Standard!
Check out this Action Alert from The National Consumer Voice. Nursing home residents need your help! Any day now, Congress will be considering legislation and a joint resolution that would prevent the implementation of the recently issued minimum staffing standard in nursing homes. This extreme legislation would not only prevent the implementation of this rul, but would permanently bar the federal government from ever issuing a rule requiring safe staffing in nursing homes. Since the staffing rule was proposed by the Biden Administration, the nursing home industry has been spending millions of dollars to oppose its implementation. They are not giving up.
The final rule issued by the Biden Administration is a modest staffing standard, that would affect mostly the worst homes in the United States. The rule is targeted at those homes that provide the least amount of care. Additionally, the rule requires that there be increased transparency in Medicaid spending and that nursing homes use evidence-based, data driven methods to assess the needs of their residents. The extreme legislation in Congress would stop these needed reforms and prevent the federal government from ever issuing a similar rule.
Please stand with nursing home residents and workers. If you have not already, tell your members of Congress to reject these efforts to prevent the implementation of the minimum staffing rule in nursing homes.
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State Opportunities to Increase Nursing Home Transparency
There are over 15,000 nursing homes (NHs) in the United States caring for 1.2 million people. While most NHs are for-profit and privately owned, they are primarily funded by taxpayer dollars. Medicare is the primary payer for Medicare beneficiaries who need rehabilitation after a hospital stay (often “short stay” residents). Medicaid is the primary payer for the majority of “long stay” NH residents, including those who have maxed out their Medicare days, and those who spend down personal savings to qualify.
Because of the very large public investment in NH care, U.S. policymakers, health care and aging stakeholders, residents, and advocates have all expressed interest in increasing operational transparency and making it easier to track where those taxpayer dollars are spent, who owns the nursing home, and how those dollars are impacting quality of care.
Check out the Better Care Playbook blog post on increased transparency. Since states bear a large responsibility for NH oversight, licensure, and certification, the blog post suggests opportunities for states to promote transparency.
The Center for Health Care Strategies (CHCS), through support from Arnold Ventures, launched the State Nursing Home Innovation & Transparency Learning Collaborative. This 12-month program is working with teams in California, Kentucky, Michigan, Oregon, and Virginia to implement innovative strategies that improve nursing home transparency and accountability. Participating state teams will identify a state project or policy to advance and develop an action plan to promote their goals. At the end of the learning collaborative, participating state teams will have the evidence, expertise, and best-practice knowledge to develop initiatives that support meaningful improvements in nursing home care for their residents.
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The Office of Inspector General (OIG) is Kentucky’s regulatory agency for licensing all long-term care facilities in the commonwealth. OIG now posts Personal Care Home inspections on their website along with Nursing Home inspection findings.
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Staff and Volunteer Spotlights
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Welcome Erika Rhodes-Chism
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Erika Rhodes-Chism is the new KIPDA District LTC Ombudsman/ Program Director serving out of Catholic Charities of Louisville. Erika has spent 2 decades in human service work including serving as the Director of Social Services for a long-term care facility in Louisville. In her new role, Erika is able to accomplish two of her favorite things- advocate for residents of long-term care and lead the outstanding team of Ombudsman serving the KIPDA community! When not working Erika loves spending time with her husband, children, and family as well as traveling to destinations near and far.
Erika is pictured with Regional LTC Ombudsman Mark Burress.
Erika serves Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, and Trimble counties. Erika is available by email at [email protected]
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Darcus serves Floyd, Johnson, Magoffin, Martin, and Pike counties.
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Darcus Hall is the new Big Sandy District LTC Ombudsman at the Big Sandy Area Agency on Aging and Independent Living in Prestonsburg.
Darcus Hall grew up in Pikeville and most recently lived in Morristown, Tennessee where she earned her bachelor’s degree in Human Services at Eastern Tennessee State University. Darcus is the proud parent of three children. She grew up in a large family of ten children and believes this has helped give her a unique perspective on problem solving and advocacy.
Darcus is available by email at [email protected]
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We are so sorry to share the loss of one of our long-time volunteers with the Barren River LTC Ombudsman Program. Gloria Peach passed away July 12. Gloria worked as a Registered Nurse for 30+ years. Once she retired, she started living her best life. She was a huge advocate for the elderly serving as an Ombudsman at multiple nursing homes for 22 years. When asked why she dedicated many years and much of her time to the LTC Ombudsman Program Gloria said, “I had a lot of love to give, and so I did. I gave.” We are so grateful she chose to give that love to residents in her advocacy for residents to have quality of life and care.
Our condolences to Gloria’s family and friends. Memories and condolences can be shared here.
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Thank you to our staff and volunteers.
You make a difference!
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Community Education and Engagement
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Empowering Mindfulness
State LTC Ombudsman Sherry Culp shared information about the detection and prevention of sexual assault of nursing home residents at the Bluegrass Mental Health and Aging Coalition’s Empowering Mindfulness Conference in Clark County.
Thank you to the coalition for on-going awareness efforts, outreach, and education around mental health and aging!
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Prepare to Celebrate!
Residents’ Rights Month is an annual event designated by the National Consumer Voice and is celebrated in October to honor residents living in all long-term care facilities. It is a time for celebration and recognition offering an opportunity for every facility to focus on and celebrate awareness of dignity, respect and the value of each individual resident. This year’s theme is The Power of My Voice. Let us know if you have any questions and how you plan to celebrate email us.
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The Resident’s Voice Challenge
Creative writing and artistic expression are meaningful and compelling ways to highlight the importance of residents’ rights and how these rights can be carried out in all long-term care settings. Residents are encouraged to get creative in demonstrating the power of their voice.
Consider using a unique medium to share your voice – make a video or audio recording describing what makes you feel empowered or what enriches your life, read a piece of original poetry or a short story, play original music or sing a song, show and tell us about your artwork, etc. Read the full Resident’s Voice Challenge Criteria before submitting.
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Effects of Essential Caregiver Policies on Deaths in Nursing Homes
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Federal authorities banned nursing home visitation in the early days of the coronavirus disease 2019 (COVID‐19) pandemic. However, there was growing concern that physical isolation may have unintended harms on nursing home residents. Thus, nursing homes and policymakers faced a tradeoff between minimizing COVID‐19 outbreaks and limiting the unintended harms. Some states implemented Essential Caregiver policies (ECPs) allowing nursing home visitation by designated family members or friends under controlled circumstances. A newly published study found that these policies reduce non‐COVID‐19 deaths in facilities with higher quality or staffing levels, while reducing COVID‐19 deaths in facilities with lower quality or staffing levels. Findings support the use and expansion of ECPs to balance resident safety and the need for social interaction and informal care during future pandemics. Check out the study Effects of essential caregiver policies on COVID‐19 and non‐COVID‐19 deaths in nursing homes
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Children’s Book on Caring for People with Dementia by Dr. Eilon Caspi
Gerontologist and dementia behavior specialist, Dr. Eilon Caspi has written a children’s book, What I’ve Learned About Grandma’s Memory. The book combines the latest knowledge and research about caring for people with dementia with the perspective of a child visiting her grandmother who lives with advanced stages of Alzheimer’s disease in a nursing home. The story helps shift perceptions from stigma to hope.
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What’s an Ombudsman?
Ombudsmen advocate for residents of long-term care facilities at no charge to residents or families.
Long-Term Care Ombudsmen
- Regularly make unannounced visits to long-term care facilities to visit residents.
- Protect the special legal rights of residents.
- Identify, investigate, and resolve residents’ problems and concerns.
- Empower residents to make informed choices.
- Work to monitor laws/policies to protect residents.
Long-term care ombudsmen serve residents in all counties in Kentucky. Visit our website!
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The Kentucky State LTC Ombudsman Program is housed within the Nursing Home Ombudsman Agency of the Bluegrass.
The KLTCOP is funded in part by state and federal funding provided by the Department for Aging and Independent Living.
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