The proposed federal staffing rule is “shockingly low” and will not measurably improve working and care conditions in nursing homes, consumer advocates claimed during a webinar that was conducted without any provider representation Tuesday.
Charlene Harrington, RN, PhD, professor emeritus at the University of California-San Francisco School of Nursing, sharply criticized the proposed federal mandate for not going far enough during the webinar presented by the Long-Term Care Community Coalition.
“They’re shockingly low,” she said of the proposed nursing hours. “The government basically ignored all of the research after lobbying by the nursing home industry.”
Nursing home operators have claimed the opposite: Regulators ignored findings of their own study, which caused an uproar when they were leaked three days early. The report stated there was no way to ascertain precise levels of staffing. Provider advocates have also strenuously argued that a “one size fits all” mandate for which the government is not allocating funds will not guarantee higher quality of care. The sector has also launched a national campaign to promote creative solutions to the national workforce shortage and help facilities find qualified employees.
Harrington, a decades-long outspoken nursing home management critic for decades, said that the Centers for Medicare & Medicaid Services was “naïve” to believe that facilities would retain the current numbers of licensed practical nurses and hire additional registered nurses to meet the proposed rule.
“They are more likely to reduce overall LPN staffing [since] there is no minimum requirement for that,” she said, adding that the phase-in period to be in compliance is “ridiculously long.”
On Sept. 1, CMS finally unveiled its proposed staffing mandate, which calls for a minimum of 3.0 hours per patient day of direct care – 0.55 hours of that by a registered nurse and 2.45 hours by a nurse aide. Non-rural nursing homes would have three years to comply with some elements of the rule, with rural facilities given five years to get up to speed on the overall hourly rate.
A requirement calling for 24/7 RN coverage, triple the current standard, would go into effect two years after the rule is finalized for urban providers, with another year granted to rural providers. The proposal does include an option for hardship waivers, an element providers had pleaded for given the sector’s ongoing workforce crisis.
But Harrington and Richard J. Mollot (pictured), executive director of the Long-Term Care Community Coalition, said the staffing problems have been created by the industry itself.
“The industry has been saying for years that they don’t have enough funding to hire staff,” Mollot said, adding that “sophisticated” owners in private equity and real estate investment trusts are purchasing facilities. “Why would they be buying into the sector if it was a money loser? There’s a lot of money being made … it’s just not going into care.”
Mollot and Harrington said they are pushing CMS — and asking allies through comments on the proposed regulation — to increase the minimum number of hours to 4.1 total nursing hours per resident day, which would include 0.75 hours of RN coverage, 0.55 hours of LVN coverage, and 2.8 hours of CNA coverage.
The 4.1 hours per resident day refers to the level recommended 20 years ago by another CMS study that was never acted on. It appears highly unlikely 4.1 would become a current day standard, at least not initially. Last year’s CMS follow-up study examined the possible effects of mandating nursing hours only as high as 3.88 hours per resident day. In addition, in their request for comments on the proposed rule, regulators asked for thoughts about raising the minimum to 3.48 hours instead.
The consumer coalition also wants facilities to be required to have a director of nursing or an assistant director of nursing on duty seven days a week. Their version of a staffing mandate rule also should be implemented within two years without any waivers.
“Nursing homes with shortages of staffing should not be allowed to admit new residents until the [nursing home] meets the minimum staffing requirements,” the group’s slide presentation stated.
The coalition also unveiled a white paper entitled, “Addressing the Nation’s Chronic Nursing Home Understaffing Crisis” that aims to debunk what it says are the LTC sector’s myths, such as needing more research to determine the proper staffing levels and that setting minimums will “reduce access to care” by forcing the shuttering of facilities.
“The problem is not the amount of funds that nursing homes are paid but, rather, how these funds are being used,” the paper said. “Studies have found that, rather than spending on resident care, too many nursing homes are devoting resources for items such as exorbitant administrative costs, unchecked related-party transactions, and excess profits.”
