Federal government will dictate staffing levels at nursing homes for first time ever, according to Biden admin

The Biden administration announced on Friday that the federal government would mandate nursing home staffing for the first time in response to the systemic problems exposed by the mass deaths from COVID-19.

Such regulations have been called for by advocates for the elderly and disabled for decades, but the proposed threshold is far lower than many supporters had hoped. This quickly provoked outrage from the nursing home industry as well, who said it amounted to an unfulfilled obligation.

With criticism expected and many Americans turning away from the news over the holiday weekend, details of a promise made to much fanfare in President Joe Biden’s 2022 State of the Union address have emerged.

“Establishing minimum staffing standards for nursing homes will improve the safety of residents,” Health Secretary Xavier Becerra said in a statement. “When facilities are understaffed, residents suffer.”

The proposed rule, which is now in a public comment period and will take several more years to fully take effect, calls for staffing the equivalent of three hours per resident per day, of which just over 30 minutes. by registered nurses. Regulations also require the RN to be present at her facility 24 hours a day, 7 days a week.

According to a government report, the average nursing home in the United States already has about 3.6 hours of total care staff staffing per resident per day, with RNs staffing just over 30 minutes. surpassed.

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Still, the government says a majority of the country’s 15,000 nursing homes, which house about 1.2 million people, will need to hire more staff under the proposed rules.

Chiquita Brooks-Rashua, who heads the Centers for Medicare and Medicaid Services (CMS), called the move an “important first step.” CMS oversees nursing homes.

A senior White House official, speaking on condition of anonymity ahead of the announcement, said the Biden administration was open to revisiting staffing standards once in place.

“I would like to warn anyone who thinks that the current state of federal nursing home staffing is preferable to the standards we are proposing,” said Stacey Sanders, an aide to Mr. Bessera. said. “The standard will increase the staffing levels of over 75% of nursing homes, have more nursing assistants at the bedside, and ensure that all nursing homes are staffed 24/7 with a registered nurse. is guaranteed.”

Residents of the Bret Hart Retirement Inn in Grass Valley, California, head to the dining room for lunch on May 6, 2020. (Elias Funes/The Union via AP, File)

The new baseline is higher than the baseline long-held by advocates after a groundbreaking 2001 CMS-funded study recommended an average of 4.1 hours of care per resident per day. is also significantly lower.

Most facilities in the US do not meet that standard. Many advocates said it was not enough to simply determine when residents could be potentially harmed, without considering quality of life.

After the Democratic president addressed the issue in his State of the Union address, supporters were initially gleeful in anticipation of the most significant change for residents since the Nursing Home Reform Act of 1987. That changed after a copy of a new study on nursing homes funded by CMS. The subject was posted in error this week, claiming that “there is no obvious plateau where quality and safety are maximized.”

Supporters said they were disappointed because they felt betrayed by administration officials they thought were allies. Some were even more outraged when the proposal was made public early Friday morning.

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Richard Morott, who heads the Long Term Care Community Coalition, said it was “totally inadequate” and “ignored any evidence” of what residents needed and weren’t using. A “once-in-a-generation opportunity” to do so is being lost, he said. The core of Biden’s pledges. He grudgingly conceded that the 24/7 RN rule could bring some small improvements to the worst facilities, but his criticism otherwise waned.

He called the move “heartbreaking” and “disgusting”, and it would impose government penalties on understaffed housing, risk wrongful death lawsuits, and do more harm than good. Said it was bigger.

“This is a gross dereliction of duty,” he said. “We continue to allow nursing homes to warehouse people and pluck money from the public.”

Katie Smith-Sloan, head of Leading Age, which represents nonprofit nursing homes, said the industry was already in a workforce crisis, with rules requiring facilities to hire additional staff at a time when they had “no people to hire at all.” He said it was pointless to make.

“To say that I am disappointed that President Biden chose to proceed with the proposed workforce ratio despite clear evidence against it would be an understatement,” he said. Stated.

Current law only mandates that each household be “adequately” staffed, but leaves most interpretations to the states. Thirty-eight states and the District of Columbia have their own staffing regulations. Some are so low that proponents claim they are meaningless, and overall enforcement is often ineffective.

This problem is associated with frontline nursing aides (underpaid, overwhelmingly female, and disproportionately underrepresented among facility staff) and those who do not ring their doorbells, shower less frequently, and are hungry. It was clear for a long time, even to the inmates themselves, who were lying in wait. Help with meals.


The COVID-19 pandemic, which has killed more than 167,000 US nursing home residents, has drawn the most attention to the talent shortage in history. However, as a result, many households have been further reduced.

Nursing home workers across all occupations are down 218,200 since February 2020, when the first coronavirus outbreak occurred in a suburban Seattle nursing home in the United States, according to Bureau of Labor Statistics data. .

The American Medical Association, the largest lobbyist representing nursing homes, has launched a relentless campaign, claiming that facilities are destabilized by insufficient Medicaid subsidies, widespread employment and retention problems, and widespread facility closures. and warned that mandating staffing would only exacerbate them. problem. But there are no signs of widespread closures, housing profitability has been repeatedly exposed, and critics argue workers will come if wages are even higher.

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