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More than 80% of nursing homes do not meet the updated requirements in the final staffing mandate from the Centers for Medicare & Medicaid Services, according to new analysis from media outlet KFF. Those findings further amplify the chorus of concerns raised by providers following the news that CMS was raising its proposed requirement of 3.0 hours of care per resident per day to 3.48 in Monday’s final rule. 

CMS leaders, including Administrator Chiquita Brooks-LaSure, attempted to address sector questions and concerns at a press event Tuesday afternoon.

“We know that some long-term care facilities, especially in rural communities, continue to see challenges in recruiting and retaining nursing home staff because of local workforce unavailability,” Brooks-LaSure acknowledged in an opening statement.

She noted baked-in measures meant to help long-term care providers adjust to the new requirements, such as a rollout period that gives urban facilities until May 2027 and rural communities until May 2028 to meet the mandate’s requirements. 

The new rule also includes temporary exemptions for facilities that can demonstrate recruiting hardship and a good faith effort to hire more staff, as well as a $75 million nursing home recruitment program to provide financial incentives to bring more nurses into the sector.

Uncertain future

Details on how much relief these programs and exemptions may grant to struggling providers remain limited. 

The federal regulator estimates that around 25% of nursing homes may qualify for the nursing hours exemption, according to Kristiana Yao, senior policy advisor at CMS. Officials repeatedly reminded attendees, however, that such exemptions would require proof of good-faith efforts to increase staffing and invest in wages.

“The core principle here is that we want every facility across the country to make strong efforts to improve their staffing ratios, to improve the quality of care.” said Jonathan Blum, principal deputy administrator and COO at CMS.

The officials acknowledged their inability to estimate how many nurses the $75 million recruitment program would recruit or if they would be enough to offset a meaningful portion of the ground nursing homes must now make up on staffing. They expressed hopes that the program would be built upon by state partners running similar ventures.

Fear and celebration  

Providers — who were already apprehensive about the initially proposed 3.0 hour mandate — have reacted this week with shock and heightened concerns about the sector’s future given a more stringent hourly standard. 

CMS officials spoke about the need to change an intolerable status quo of low staffing and poor quality care at the press event Tuesday. Providers, meanwhile, argue that the mandate could force facilities to close and put senior care in peril in the many already-struggling areas around the nation.

A coalition of long-term care leaders in Minnesota estimated that only 5% of that state’s providers are currently able to meet the new standards — far lower than the 19% nationwide estimated by KFF. They called on policymakers to renew their efforts to invest in aid for nursing home staffing.

“We need state and federal lawmakers to partner with providers to build a pipeline of professional caregivers to meet the growing demands for senior care,” read a statement from The Long-Term Care Imperative — a partnership between the Care Providers of Minnesota and LeadingAge Minnesota.

“Given the persistent workforce crisis, which limits our ability to recruit and retain staff, and the astronomical costs of the rule, we are disappointed that CMS didn’t sufficiently moderate the rule despite our advocacy,” continues the statement, provided to McKnight’s Tuesday. “There are potentially devastating and long-lasting impacts, such as nursing homes being forced to close if they cannot meet the new staffing mandates. These closures would affect the ability of vulnerable adults to receive needed care.”

Consumer advocates, such as The National Consumer Voice for Long-Term Care, have not only celebrated the mandate from CMS, but called for even stronger regulations and fewer relief options for providers.

“Consumer Voice recognizes that this is an important first step in ensuring that all residents have their care needs met,” the advocacy group wrote Monday. “However, 3.48 [hours per resident per day] is a minimum and not a ceiling. Federal law requires that each facility have sufficient staff to meet the needs of all residents. Most residents will require care that exceeds the 3.48.”