Centers for Medicare & Medicaid Service (CMS), the federal agency that oversees Medicare and Medicaid, has proposed new mandatory minimum standards for nursing home staffing. Nursing homes will have 3 years to comply with the new staffing requirements, which would require 3 hours of patient care daily including hours by a registered nurse. Rural facilities would be given longer to meet the requirements. The proposed rule also includes 24/7 RN coverage, which is 3 times the current requirement of only 8 hours, 7 days a week.

Interestingly, the proposed 3 hours per day of patient care is substantially below the recommended 4 hours per day that a CMS study previously endorsed. However, 75% of nursing homes do not currently meet the proposed staffing requirements and would have to hire additional staff to do so. While consumer groups and the disability community have advocated for higher staffing standards, especially in the wake of the pandemic, the nursing home industry has strongly opposed them. The industry argues that they face difficulty meeting even their current staffing needs, with Elder Care nurses being especially hard to hire. Industry groups note that they anticipate they will not be able to return to pre-pandemic staffing levels until 2027.

Another interesting provision in the proposed rule would require facilities to report the breakdown of how Medicaid payments that facilities receive are spent, including the percent going to compensation of direct care workers.

These new staffing standards take an approach that goes substantially beyond the staff-to-resident ratios enacted in New Jersey in 2020. Staffing and financial challenges facing nursing homes point to the importance of developing more home- and community-based options and finding other innovative ways to care for the needs of our aging population.