Biden Admin Imposes Controversial Staffing Requirements for Nursing Homes

WASHINGTON, D.C. — A first-of-its-kind federal minimum staffing requirement for nursing homes was finalized this week. The Biden Administration’s final rule will mean big changes at roughly 15,000 nursing homes around the country. 

Neglect and abuse at nursing homes have been major concerns for years. The deaths of over 160,000 nursing home residents from COVID-19 brought the issue front and center. 

This new rule is a welcomed sign for many who say living situations at nursing homes have to be addressed. But the long-term care industry warns the new rule will have a dire impact on access to care. 

The rule applies to nursing facilities that receive Medicare and Medicaid funding. It will require a registered nurse (RN) to be on-site in every skilled nursing facility for 24 hours a day, seven days a week.  

“It’s critically important to provide quality of care. That’s what our families expect and that’s what these facilities should provide,” said Senator Bob Casey (D- PA). 

The rule will require enough staff to provide every resident with at least 3.48 hours of care each day. 

“It basically means three and a half hours of direct care per day per resident. That’s not a lot to ask of an industry to make sure that they can provide that level of care,” said Sen. Casey, who has sponsored legislation in the past, similar to what the new rule calls for.  

“Of that three and a half hours of care per resident per day, part of that is making sure that a nurse is available to see that individual at least a half an hour of that. Most of it, about two and a half hours, will be certified nurses aides caring for that individual,” Casey added. 

The long-term care industry has been extremely outspoken against the minimum staffing requirements, saying the rule will fuel the access to care crisis. 

“This is a mandate or a rule given by bureaucrats in Washington, D.C., that is supposed to improve care all across the country. Once again, it will do exactly the opposite,” said Zach Shamberg, the President and CEO of the Pennsylvania Health Care Association (PHCA). 

Acccording to a study by the American Health Care Association, nursing homes across the country would need to hire more than 100,000 additional workers to meet the requirement: 80,077 nurse aides (NAs) and 22,077 registered nurses (RNs). The study also estimates the mandate could cost nursing homes approximately $6.8 billion per year. 

The largest impact will be felt in states with a large aging population, like Pennsylvania. 

According to the Pennsylvania Health Care Association, the new federal rule as well as state staffing ratios will require over 16,000 more caregivers, totaling about $540 million which accounts for recruitment, training, wages and benefits.  

With a major staffing shortage facing the industry- one that was exacerbated by the COVID-19 Pandemic- Shamberg says the final rule is not practical. 

“If we can’t find workers, then providers will be forced to essentially take beds offline and close their doors to new and prospective residents. That’s why this will fuel the access to care crisis,” said Shamberg.  

“The Biden Administration’s federal staffing rule is a staggering disappointment to nursing home providers everywhere. This is especially true in Pennsylvania where we’re already seeing the impacts of underfunded, ill-timed state mandates firsthand,” said LeadingAge PA President and CEO Garry Pezzano. 

Nursing home operators in urban areas will have three years to comply with the rules, while rural operators will have up to five years. Those in rural areas without enough workers could qualify for temporary hardship exemptions. 

Sen. Casey says the government needs to do a better job in investing in long term care, especially when it comes to building the workforce. 

“We can’t just simply say to the industry, ‘you’ve got to provide a minimum level of staffing to bring about quality care.’ We’ve got to help nursing homes, we’ve got to invest in long-term care. And that means helping them raise wages for their workers, so we not only have the best rules in place for care, but we have the best workforce in the world. That has to be the goal,” said Casey. “Unfortunately, we’re a long way from that, we have a lot more to do on workforce and I’ve got a bill to address that,” Casey added. 

The long-term care industry is now advocating for a bill in Congress to stop the rule. 

“In lieu of taking meaningful action to address the workforce crisis in long-term care, PHCA is calling on Congress to immediately advance the Protecting Rural Seniors Access to Care Act to stop this federal mandate and allow Pennsylvania to care for its seniors and adults with disabilities,” said Shamberg.