Q: I’m concerned about the proposed CMS nursing home staffing mandate. Will hardship exemptions save operators who have difficulty meeting staffing needs?
A: You are right to be concerned. CMS proposed the rule as the industry deals with an unprecedented labor shortage resulting from increased patient demand and high turnover exacerbated by COVID.
The rule would require nursing homes to provide at least 3.0 nursing hours per resident day, including at least 0.55 RN hours and at least 2.45 nurse aide hours. CMS acknowledged a nationwide nursing shortage by including a waiver process.
The proposal recognizes that, despite operators’ best efforts, many facilities will have difficulty meeting the requirements due to local workforce unavailability, competition from higher-paying positions, and other challenges. But facilities must meet four specific criteria to qualify for a hardship exemption. The proposed criteria examine the (1) facility location to determine whether it is in an area where the supply of applicable healthcare staff is insufficient to meet local needs or is 20 miles or more from the next closest facility; (2) whether the facility demonstrated a good faith effort to hire and retain staff through a documented recruitment and retention plan that includes prevailing wages; (3) whether the provider demonstrated a financial commitment through annual expenditures on nurse staffing relative to revenues; and (4) exclusion issues such as past citations for staffing issues, selection to the Special Focus Facility program or failure to submit Payroll-Based Journal data.
While that process may provide relief, the government is placing too great a burden on operators while failing to play a larger role in developing a comprehensive plan that reduces the impact of societal and demographic shifts that have led to the current nursing shortage.
From the November 2023 Issue of McKnight's Long-Term Care News
