CMS sets minimum staffing standards for nursing homes

A new final rule from CMS establishes minimum staffing standards for nursing homes at a national level for the first time in history.

The rule states that nursing homes participating in Medicare and Medicaid must provide residents with a minimum of 3.48 hours of nursing care per day. The new staffing standard includes at least 0.55 hours of care from a registered nurse per resident per day and 2.45 hours of care from a nurse aide per resident per day.

Additionally, nursing homes in the federal programs will also need to have a registered nurse on-site at all times to provide skilled nursing care to prevent patient safety events.

The final rule also establishes enhanced facility assessment requirements and staffing plans to maximize workforce recruitment and retention.

The minimum staffing standards for nursing homes are a first from CMS, which builds on the Biden Administration’s April 2023 Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers. The Executive Order focuses on improving early education and long-term care, with a nod to “nursing home staffing transparency to promote adequate staffing at nursing homes.”

CMS says the new staffing standards will improve care for nursing home residents while supporting workers by ensuring there are sufficient staff to manage patients. The updated facility assessments should also help nursing homes determine their staffing needs and whether they need to be above the staffing standards based on resident acuity and individual care needs.

New facility assessments will differ from existing assessments and annual reviews nursing homes currently use. The rule finalizes a requirement for evidence-based methods when care planning for residents, including planning for behavioral health needs, as well as a requirement for assessments of specific needs for each resident within a facility. The assessment must also include input from nursing home leadership, as well as residents and their representatives.

The new standards will be implemented in phases, with CMS staggering the effective dates for the minimum nurse staffing standards and the 24/7 registered nurse requirement. Implementation will be based on geographic location, with possible exemptions based on workforce availability and other factors impacting nursing home staff in certain areas. For example, rural areas are especially challenged by workforce shortages and struggle to attract and retain staff with minimal resources.

Nursing homes will need to meet facility assessment requirements within 90 days of the final rule’s publication, which is slated for May 10th. Within two years of the final rule’s publication, nursing homes will need to meet at least 3.48 hours per resident day and the 24/7 registered nurse requirement.

Finally, the full minimum staffing standards finalized in the rule will be effective within five years of the rule’s publication.

CMS also says in the rule that it will also invest over $75 million in a national nursing home staffing campaign to bolster the nurse workforce in the sector. The campaign will provide financial incentives, including some tuition reimbursement, to nurses working in the nursing home environment and make enrollment in nurse aide training programs easier.