Despite stiff industry opposition to the Biden administration’s proposed new mandates for nursing home staffing to be phased in over the next several years, federal data shows many facilities already meet the new standards.
In April, the federal Centers for Medicare and Medicaid Services published a new rule that over the next five years would establish additional requirements for staffing levels in nursing homes.The new rule touched off a firestorm of protests from industry officials who said the requirements will drive care facilities into bankruptcy, and from senior advocates who asserted the new requirements are too weak.
A recent analysis by KFF, formerly the Kaiser Family Foundation, shows that while only 19 percent of all nursing facilities nationwide currently meet all three of the rule’s new staffing minimums, almost 60 percent of the homes already meet the overall requirement of providing every resident with 3.48 hours of care each day.
In Iowa, where care facilities are cited for insufficient staffing at a much higher rate than the national average, 54 percent of homes already meet the overall requirement of providing every resident with 3.48 hours of care each day.
The KFF analysis shows many Iowa homes currently meet the other new standards:
- 71 percent of the Iowa nursing homes now meet the requirement for .55 hours of care, per resident, per day, by a registered nurse.
- 39 percent of the Iowa homes now meet the requirement for 2.45 hours of care, per resident, per day, by a certified nurse aide.
- 32 percent of Iowa’s nursing homes meet all three of the new requirements — a significantly higher percentage than the national average of 19 percent.
The KFF study also shows that while only 11 percent of the nation’s for-profit facilities currently meet all requirements in the final rule, 41 percent of the nonprofit homes meet all of the standards — suggesting profit motives may be a factor in suppressing staffing.
One finding in the study challenges the notion that rural facilities, which must draw from a smaller pool of available labor, will have a harder time meeting the new standards. The study shows that rural nursing homes are just as likely as urban facilities to meet the requirements — although the rule will give them more time to come into compliance.
In May, the New York-based Long-Term Care Community Coalition issued its own detailed report outlining the staffing levels at every Medicare-certified nursing home in the nation during the fourth quarter of 2023. The findings in that study are similar to those in the KFF report.
The coalition’s report indicated the Iowa homes with the lowest nurse staffing levels in the fourth quarter of 2023 were Arbor Springs of West Des Moines, Midlands Living Center of Council Bluffs, Linn Haven Rehab & Health Care of New Hampton, Pleasant Acres Care Center of Hull, Northbrook Healthcare and Rehabilitation Center of Cedar Rapids, Crest Haven Care Centre of Creston and Aspire of Perry.
All of those homes reported less than 2.5 hours of total nursing care per resident, per day, according to the report.
A separate set of data published by the Centers for Medicare and Medicaid Services indicates that 14 percent of Iowa’s nursing facilities were cited for insufficient staffing in fiscal year 2023. That’s more than double the national average of 5.9 percent.
Federal rule follows unenforced state mandates
The new federal staffing rule is expected to be phased in over time. The first phase calls for staffing assessments that take into account the needs of each resident, and that took effect Thursday.
The second phase will require homes to have a registered nurse on duty 24 hours per day, seven days a week, and ultimately will require homes to provide an overall total of 3.48 hours of care, per resident, per day. This phase will take effect at urban facilities in May 2026, and at rural facilities in May 2027. Homes will be able to apply for a “hardship exemption” from the 24/7 registered-nurse requirement.
The third phase, which will require nursing homes to deliver a minimum of .55 hours of care, per resident, per day, by a registered nurse, and 2.45 hours of care each day by a certified nurse aide, will take effect at urban facilities in May 2027, and at rural facilities in May 2029.
More recent reporting by KFF suggests that state-imposed staffing mandates on nursing facilities don’t always have the desired effect of increasing the care that’s provided residents, largely because those standards are not enforced.
Rhode Island, California, New York, Florida and Massachusetts each have established minimum hours of care per resident. But a KFF review of employment records in those states shows many nursing homes operate with fewer workers than required and face no consequences. In some case, state regulators waived the staffing requirements.
In other states, legislatures have rolled back more stringent staffing requirements. In Florida, Gov. Ron DeSantis signed legislation in 2022 to loosen that state’s previously mandated staffing levels.Currently, KFF reported, four out of five Florida homes do not meet the previously imposed, more rigorous staffing requirements.
The fact that many care facilities nationwide already meet the new minimum standards while still facing quality-of-care issues has been an issue with many advocates who say the new standards don’t go far enough.
They point to a federal study that shows each resident needs at least 4.1 hours of nursing care each day — which is a standard met by only 26 percent of all nursing homes nationally and 24 percent of all homes in Iowa, according to the Long-Term Care Community Coalition.
This article first appeared in the Iowa Capital Dispatch.
