Only 19% of Nursing Homes Currently Meet Proposed Staffing Standards

Less than 20 percent of nursing homes currently meet the proposed staffing standards for long-term care facilities, a KFF brief revealed.

In September, CMS released a proposed rule with three main staffing requirements for nursing homes participating in Medicare and Medicaid. Facilities must provide each resident with a minimum of 0.55 hours of care per day from a registered nurse (RN) and 2.45 hours of care per day from a nurse aide.

Nursing homes must also have an RN onsite 24 hours per day, seven days a per, and complete enhanced facility assessments on staffing needs.

Using Nursing Home Compare data from nearly 15,000 nursing facilities, the KFF brief assesses the share of facilities that would meet the proposed standards for the minimum number of RN and nurse aide hours.

KFF found that just 19 percent of nursing facilities would meet both staffing standards, indicating that 81 percent would need to hire more staff to comply. Around half (52 percent) of nursing homes meet the RN hours per resident day requirements, while 28 percent meet the nurse aide requirement.

The majority of for-profit nursing homes would need to hire more RNs or nurse aides to meet both standards, compared to 60 percent of government and non-profit facilities. Similarly, for-profit nursing homes were more likely to not meet the individual standards for RNs and nurse aids compared to government and non-profit facilities.

While most nursing facilities would not currently meet the proposed staffing standards, the percentage varied across states. For example, in Louisiana, almost none of the nursing homes would meet the requirements, but all of the facilities in Alaska meet the standards.

In over half of states, less than 25 percent of facilities meet both the RN and nurse aide requirements. In 16 states, between 25 and 49 percent of facilities meet the standards, while more than half of nursing homes in six states meet the provisions.

“Variation across the states is likely to reflect many factors, including what percentage of facilities are for-profit, the availability of RNs and nurse aides in the state, and state requirements regarding minimum staffing levels,” the brief stated.

CMS requested feedback on whether there should be an additional requirement for nursing homes to maintain staffing levels of 3.48 hours per resident day. In addition to the 0.55 hours from RNs and the 2.45 hours from nurse aides, facilities could use any nursing staff for the final 0.48 hours.

The share of nursing homes that meet the 3.48 hours per day requirement did not significantly differ, with 18.9 percent meeting the alternative standard.

CMS also proposed using a case mix adjustment that would increase staffing level requirements for facilities with residents that have higher health or functional needs.

If the agency moved forward with the case-mix adjusted staffing level, only 38 facilities (0.3 percent) would meet the RN and nurse aide hours requirements. Around 4 percent of nursing homes would meet the standard for RNs and 0.3 percent would meet the requirements for nurse aides.

Should the staffing requirements be finalized, nursing facilities will likely struggle with compliance as staffing shortages continue. Facilities will have to increase operation costs to recruit and retain additional staff.

Additionally, CMS estimates that complying with the proposals will cost $40 billion in the ten years after the final rule takes effect—costs that will likely be passed on to public and private health plans and residents.