BOSTON — Nursing homes would be required to meet stringent staffing requirements under new Biden administration rules that the long-term care industry says are “unattainable” and could force some facilities to close their doors.
The new Centers for Medicare and Medicaid Services rules, which were finalized last month, will require nursing facilities that receive federal funding through the programs to employ enough staff to provide at least 3.48 hours of daily care for each resident.
That includes 2.45 hours of nurse aide time and 0.55 hours of registered nurse assistance. Facilities also must have a registered nurse on site 24 hours-a-day, seven days a week.
The White House says the new rule will require nursing facilities with 100 residents to have at least two registered nurses and at least 10 nurse aides as well as additional care staff per shift. Facilities caring for residents with higher needs will be required to increase staffing above the minimum levels, according to the new rules.
Additionally, the Biden administration is requiring home care agencies allocate at least 80% of their Medicaid payments to staff compensation. States would have flexibility to adjust the rules for small and rural home care providers, according to the directive.
Nursing home operators that fail to meet the new federal standards could lose Medicare and Medicaid funding, effectively putting them out of business.
“Medicare and Medicaid pay billions of dollars per year to ensure that 1.2 million Americans that receive care in nursing homes are cared for, yet too many nursing homes chronically understaff their facilities, leading to substandard or unsafe care,” the White House said in a statement.
“When facilities are understaffed, residents may go without basic necessities like baths, trips to the bathroom, and meals – and it is less safe when residents have a medical emergency,” the statement said.
But the Massachusetts Senior Care Association, which represents nursing homes, said the new rules are “simply unattainable” for nearly every facility and, if implemented, “would lead to widespread disruption in accessing skilled nursing facility care.
The association said the workforce crisis — with more than 7,000 vacant positions in nursing facilities — is “directly contributing to the current instability throughout the Massachusetts health care system.”
“CMS’ failure to provide funding to hire, train and upskill the thousands of individuals necessary to meet the requirements of the final rule is projected to cost over $175 million annually in the commonwealth alone,” Tara Gregorio, the group’s president, said in a statement.
Gregorio said the association is “fully committed to working with our government partners to secure the funding necessary to hire additional direct care workers, increase wages for our deserving staff, and to promote career pathways.”
A MassHealth spokesperson said the agency, which oversees nursing homes, is “deeply committed to ensuring that members receiving services at nursing facilities across the state are getting excellent care.
“We are currently reviewing the rule and its impact and look forward to working with our federal, state, and local partners,” the statement said.
The state Department of Health’s long-term care facility regulations require a minimum of 3.580 hours of care per resident a day, 0.508 hours of which must be by a registered nurse. That’s higher than the standard for the new CMS regulation.
DPH regulations also require 24 hour nursing service with an adequate number of trained nursing personnel on duty around the clock, according to the state agency.
The Centers for Medicare and Medicaid Services estimates that roughly one-quarter of facilities would meet the minimum nursing requirement, including the onsite 24/7 rule.
But the American Health Care Association, a trade group representing for-profit nursing homes, says about nine in 10 facilities would fail to meet at least one of the new staffing requirements. One-third of facilities would fail to meet all three standards, the group said.
“While it may be well intentioned, the federal staffing mandate is an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors’ access to care,” AHCA President and CEO Mark Parkinson said in a statement. “It is unconscionable that the Administration is finalizing this rule given our nation’s changing demographics and growing caregiver shortage.”
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at [email protected]
By Christian M. Wade | Statehouse Reporter
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