The nursing home industry says the cost and a shortage of nurses make it impossible to comply with a new federal rule on staffing levels in nursing homes. (Getty Images)
The Biden administration has introduced a controversial set of new regulations intended to increase staffing levels and improve patient care in nursing homes.
The new staffing rule from the Centers for Medicare and Medicaid Services has faced fierce opposition from the industry and Republicans in Congress. It establishes for the first time national minimum staffing requirements for nursing homes that collect taxpayer money through Medicare- and Medicaid-funded services.
The staffing requirements will be phased in over the next two to five years, and CMS has made provisions to grant exemptions for care facilities in rural areas, such as Iowa, where there’s a shortage of available caregivers.
In a written statement, the administration said it believes that by improving working conditions and wages, improvements in the recruitment and retention of direct care workers will follow, enabling nursing staff to provide safer, higher quality care to all residents.
Inadequate staffing has long been considered the single biggest contributor to poor quality care in nursing homes.
CMS officials said Tuesday they don’t expect the new rule to force any facilities to close, noting that some states have imposed even higher staffing level requirements with no resulting shutdowns.
The new rule has been two years in the making, and CMS has fielded more than 46,000 public comments on it from caregivers, residents, industry representatives and resident advocates.
Toby S. Edelman, a senior policy attorney for the Center for Medicare Advocacy and a national expert on long-term care, noted Tuesday that the new rule announced this week establishes only “the minimum permissible staffing levels” care facilities must meet.
“The rule does not end the discussion about staffing levels,” she said. “Under federal rules issued earlier, all facilities are also required to conduct, at least annually, a facility assessment. This process requires each facility to determine the actual nursing needs of its own residents and to ensure that it has enough staff and that its staff have the necessary skills to meet its residents’ needs. Properly implemented and enforced, the facility assessment process will require many facilities to implement higher staffing levels than the minimums announced today.”
The specific provisions of the new rule include elements related to staffing, public disclosure and resident assessments:
Nursing care: Residents must receive at least 3.48 hours of nursing care per day, which would include at least 0.55 hours of care from a registered nurse per resident, per day, as well as 2.45 hours of care from a certified nurse aide per resident, per day.
Around-the-clock nurse availability: All homes must have a registered nurse on site 24 hours per day, seven days per week. The nurse must be available to deliver critical care to residents at any time.
Self-assessments: Aside from meeting the new minimum standards, all facilities will be required to perform annual assessments to determine the actual level of staffing needed to meet all residents’ needs. Those assessments, which will be more detailed than those currently required, are intended to address the fact that many care facilities already meet the new minimum standards but are still failing to meet residents’ needs due to heightened levels of acuity or the need for one-on-one supervision.
Staff retention: Each facility will be required to at least develop a formalized plan to maximize their workforce recruitment and retention efforts. To help ensure compliance, CMS will also be requiring states, to which much of the enforcement efforts are delegated, to collect and report on the percentage of Medicaid payments spent on compensation for direct care workers and support staff.
CMS has promised to publicly report the spending data collected by the states, and the states themselves will also be required to report facility-specific data on publicly accessible websites.
The federal agency has also pledged $75 million to be spent on a national nursing home staffing campaign aimed at increasing the number of nurses working in long-term care facilities. As part of that effort, CMS will be providing financial incentives for nurses to work in?nursing homes.
In announcing the new requirements, CMS acknowledged that some facilities are “experiencing challenges in hiring and retaining certain nursing staff because of local workforce unavailability.” To address that, the agency will offer waivers for the rule requiring a nurse to be on site 24-hours per day, and will also offer “financial hardship exemptions” to the staffing requirement.
The facilities that seek such an exemption will first have to show they’re in an area where the supply of nurses at least 20% below the national average as calculated by the U.S. Bureau of Labor Statistics and U.S. Census Bureau.
They’ll also have to provide documentation of good faith efforts to hire and retain staff, including the payment of competitive wages, and they’ll have to disclose the amount of money spent on nurse staffing relative to the home’s total revenue.
Facilities that are granted an exemption will then have to post a notice of its exemption status in a prominent, publicly accessible location inside the facility, and will have to provide any prospective residents with written notice of the exemption status.
Some homes will not be considered for exemption, including those on CMS’ list of special-focus facilities that have history of repeat, serious violations, and those recently cited for a pattern of insufficient staffing that has resulted in harm to residents.
For most facilities, the new staffing requirements will be phased in over the next two years, but that timeline has been extended to accommodate the needs of rural facilities where the workforce shortage is particularly acute.
Rural facilities will have 90 days to meet the new rule on facility assessments. They’ll have three years to meet the requirements on 3.48 hours of total nurse staffing and a 24-hour nurse, and five years to meet the more specific requirements of 0.55 registered-nurse hours per day, per resident.
Iowa Capital Dispatch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions: [email protected].?
]]>Republican presidential candidate and former U.S. President Donald Trump gestures as he wraps up a campaign event on Dec. 19, 2023 in Waterloo, Iowa. (Photo by Scott Olson/Getty Images)
The Republican presidential frontrunner warned Iowans Tuesday that “the American dream is dead” and “the world is in flames,” as he raised the specter of a global nuclear conflict that will result in complete “obliteration.”
Former President Donald Trump, who has a commanding leading in the polls just five weeks before the Iowa caucuses, also doubled down on his recent controversial public comments suggesting that the “blood of our nation” is being destroyed by immigrants.
He did not mention Tuesday’s decision by the Colorado Supreme Court to block him from the ballot in that state under a Civil War-era “insurrection clause,” based on his actions related to the Jan. 6, 2021 attack on the U.S. Capitol.
Speaking in Waterloo to a crowd of supporters that included Iowa Attorney General Brenna Bird, Trump said that while the threat of World War III — he didn’t specify the combatants or the cause of the conflict – is imminent, he alone has the power to pull the world back from the brink of destruction.
“I’m the only candidate, and I think you know this, that can make this very important promise,” he said. “I think the world is in more danger than it’s ever been because of the power of weaponry, and I will be the only one that can say this with great surety: I will prevent World War III. World War III, we’re very close. I don’t know if you feel it. I don’t know, madam attorney general, if you feel it, but we’re very close to World War III when you see these discussions taking place.”
Throughout his hour-long speech, Trump credited himself for rebuilding the military to “tippy top” condition, saving the ethanol industry in Iowa, and restoring the ability of people to wish each other “Merry Christmas.” He also reiterated his disproven claim that the 2020 election was “rigged.”
In the process, he described America as a country that has “gone to hell” and as “a nation in decline,” which he blamed on the policies of Democrats and the Biden administration.
“With your vote in this election, together we’re going to save America and we’re going to bring our country back from hell,” he said. “As long as Joe Biden is in the White House, the American dream is dead. There is no American dream. But all of that will change the minute the polls close on Election Night in 2024. It’s gonna all change.”
He said that “by Christmas next year” – which would predate his taking office, should he win the general election – “the economy will be roaring back, energy prices will be plummeting and the hordes of people charging across our border will have totally ended and the invasion will have stopped.”
The crowd seemed most appreciative of Trump’s comments on illegal immigration, which lately have drawn criticism, even from GOP leaders, who say his rhetoric echoes that of Adolf Hitler in the German dictator’s manifesto, “Mein Kampf.” In his book, Hitler characterized immigration and the mixing of races as “blood poisoning,” which is the same phrase Trump used recently in a New Hampshire speech.
“We have no idea who any of them are,” Trump said of the immigrants entering the United States. “They come from Africa. They come from Asia. They come from South America. But not just South America. All over the world. They dump them on the border, and they pour into our country … They are ruining our country. And it’s true: They are destroying the blood of our country. They’re destroying our country. They don’t like it when I said that? — and I never read ‘Mein Kampf.’ They said, ‘Oh, Hitler said that’ – in a much different way.”
He said immigrants now entering the United States “could be very unhealthy, they could bring in disease that’s gonna catch on in our country, but they do bring in crime… We’re gonna have to get them out. We’re gonna have to get mass numbers of these – especially the criminals. They’re coming from jails, prisons. They’re coming from mental institutions. They say, ‘Please don’t say the words insane asylum.’ But I have to say it: They’re emptying out the insane asylums from all over the world. Why wouldn’t they? I would do it, if I were running Guatemala, El Salvador, Honduras, Mexico. They’re emptying out their prisons into our country.”
The Waterloo crowd cheered loudly when Trump vowed to “indemnify all police officers and law enforcement officials throughout the United States” in order to protect them when they take “strong action” in response to reports of crime.
“They’re under threat of losing their pension, their house and their family, and losing everything if they touch these people,” he said, in an apparent reference to police altercations with lawbreakers. “Our police know everything, and they can solve these crime problems very quickly — but they’re not allowed to do it… So, what I am going to do is give indemnifications to any police officer that gets in trouble for pursuing a criminal.”
Trump has expanded his lead over his rivals for the GOP nomination, and now is the first choice of 51% of likely caucusgoers, according to the latest NBC News/Des Moines Register/Mediacom poll.?Trump’s lead in Iowa is the largest ever recorded at this stage of a campaign, and appears to be fueled in part by evangelical voters.
This article is republished from the Iowa Capital Dispatch a sister publication of Kentucky Lantern and part of?States Newsroom, a network of news bureaus supported by grants and donors as a 501c(3) public charity.?