Medicare, Medicaid to Take Closer Look at Nursing Home Staffing

CMS has updated guidance on minimum health and safety standards that long-term care facilities must meet to participate in Medicare and Medicaid. The guidance specifically addresses nursing home staffing concerns that some say have impacted care quality.

The agency also updated and created new guidance for surveyors of long-term care facilities who determine whether facilities comply with CMS requirements. The new requirements made as part of the recent update incorporate the use of Payroll Based Journal staffing data. CMS has instructed surveyors to use the data for long-term care facility inspections. The agency said the data will “help better identify potential noncompliance with CMS’s nurse staffing requirements,” including a lack of a registered nurse for eight hours each day.

“This guidance will help to uncover instances of insufficient staffing and yield higher quality care,” CMS added in the announcement.

The updated guidance also provides more information on the role of infection preventionists (IPs) in long-term care facilities. CMS said that Ips are critical to mitigating the start and spread of infectious diseases, such as COVID-19. Therefore, the agency is requiring each facility to have an IP on staff who can oversee infection prevention and control programs.

Long-term care facilities were hit hard with COVID-19 infections. According to a Government Accountability Office (GAO) report from last year, most nursing homes experienced multiple COVID-19 outbreaks and those outbreaks typically lasted five or more weeks.

CMS also said in the latest announcement that it “has highlighted the benefits of reducing the number of residents in each room for preventing infections and the importance of residents’ rights to privacy and homelike environment.”

The updated guidance aims to reduce nursing home overcrowding by encouraging facilities to find more ways to have single occupancy rooms for residents, or at least allow for a maximum of double occupancy per room.

“As the COVID-19 pandemic highlighted, we have a pressing moral responsibility to ensure that residents of long-term care facilities are treated with the respect and dignity they deserve,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “CMS is proud to be leading President Biden’s initiative to improve the safety and quality of care in the nation’s nursing homes, and this set of improvements is our next step toward that goal.”

Long-term care facility advocate LeadingAge pointed to the issue of COVID-19 outbreaks over the past couple of years as a reason why CMS should pull back on nursing home requirements.

“As we have emphasized since the Biden Administration rolled out its nursing home initiative months ago, access to quality nursing home care is a goal shared by older adults, families, policymakers, and providers,” Katie Smith Sloan, president and CEO of LeadingAge said in a statement yesterday. “Yet at this time when the sector is finding its footing after years of COVID-induced financial stress and workforce challenges, continuing the additional pile-on of regulations will strain already-stretched providers.”

“We all know that staffing goes hand-in-hand with quality care, and our mission-driven members are working valiantly to stay compliant. But we continue to urge the administration to back its words of commitment to ensuring older adults’ access to care with meaningful action and funding,” Smith Sloan added.

The surveyor changes are slated to take effect on Oct. 24, 2022.