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Consumer advocates are pushing Senate leaders to pass two staffing proposals — that providers have estimated would cost nursing homes $12 billion — after a new study found few states have implemented strict minimum staffing measures. 

The report released this week by the National Consumer Voice for Quality Long-Term Care cited a 2001 federal recommendation that suggested a daily minimum standard of 4.1 hours of total direct care per resident. It said 2.8 hours of care from certified nursing assistants, 0.75 hours from RNs and 0.55 hours from licensed practical/vocational nurses were needed to ensure high quality of care at skilled nursing facilities.

Based on that standard, researchers found that the District of Columbia is the only area meeting the recommendation, while 29 states require less than 3.5 hours. 

Findings also revealed that only five states(Colorado, Connecticut, Delaware, Maryland and Rhode Island), and Washington DC,  require a RN to be present 24/7 at all facilities. 

Within the past year, four states (Arkansas, Connecticut, New York and Rhode Island) passed legislation on staffing requirements, according to the report. Both New York and Rhode Island established a direct care minimum, while Connecticut increased its direct care minimum requirement. In Arkansas, the staffing standard changed from a per shift ratio to hours per resident per day. 

Two provisions included in the House version of President Joe Biden’s Build Back Better Act calls for the Health and Human Services secretary to conduct a study to determine the ideal minimum nurse staff-to-resident ratio for SNFs and then mandate that minimum requirement for facilities, and nursing homes  to have an RN  present 24 hours per day. That would be an increase from the current federal requirement of eight hours.

The American Health Care Association has pushed back against the “unfunded” provisions and estimates that the additional staff would cost providers $12 billion total.

Consumer Voice, however, is pushing for the Senate to include the policies as it prepares to vote on the overall bill after the report’s findings. 

“Weak federal staffing requirements combined with woefully inadequate state standards can lead to dangerously low staffing levels and deadly consequences for residents,” Robyn Grant, report author and Consumer Voice’s director of public policy and advocacy, said Thursday. 

The full report is available here.