Image of nurse working at laptop

State lawmakers are showing an appetite for mandatory healthcare staffing rules, with new nursing home-specific or tough hospital proposals on the table in at least four additional states.

In Virginia this month, legislation carried over from the previous term recently passed out of the state House Appropriations Committee by a vote of 20-2. It requires that nursing homes have at least 3.08 hours of total nurse staffing hours per resident per day. Facilities will have five years to reach that level or face penalties not to exceed either up to $1,000 per day or $25 per licensed or certified bed per day. 

The lead sponsor, Del. Robert D. Orrock, Sr. (R-Spotsylvania), could not be reached for comment.

Approximately 60% of nursing home residents in Virginia are Medicaid recipients, and facilities can earn higher payments for meeting staff metrics. Comments made by W. Scott Johnson, a lobbyist for the Virginia Health Care Association, at a committee hearing last week indicate his organization has come to support staffing improvements tied to financial incentives.

In other states, healthcare provider organizations and frontline staff appear to be on different sides of legislation either recently introduced or expected to be soon. Workers and lawmakers have backed proposals calling for hospital staffing ratios or other standards in Massachusetts, Washington and Oregon, with unions arguing that nurses are burned out from caring for too many patients at once.

Providers, on the other hand, remain concerned about widespread workforce shortages and the ability to hire the help needed to meet proposed standards in any setting.

CMS announced last year it would pursue a national minimum staffing level for nursing homes to ensure resident safety and quality of care. A month later, the American Health Care Association issued a report showing that it would cost up to $10 billion per year (since increased to $11 billion) and require nursing homes to hire approximately 187,000 nurses. The report found that just 6% of nursing homes had 4.1 hours of care per patient per day, a figure floated for at least a decade after an academic study. 

AHCA said the 4.1 hours of care standard could force 205,000 residents out of their nursing homes if facilities must make adjustments to comply with higher staffing standards. Already, six in 10 nursing homes are limiting new patient admissions due to the loss of more than 200,000 workers since the pandemic started, the association said. It added that federal proposals are being made without “corresponding resources despite the industry already facing a historic staffing crisis.”

The proposed 3.08 hours per day in Virginia’s bill is similar to Maryland’s requirement but lower than Washington, DC’s 4.16-hour threshold. A report issued last year from the Virginia General Assembly’s Joint Commission on Health Care said that 21% of nursing homes did not meet staffing levels required by CMS, according to the Richmond Times-Dispatch.