CMS Announces Nursing Home Minimum Staffing Rule

On April 22, 2024, the Centers for Medicare and Medicaid Services announced a new final rule requiring minimum staffing levels in nursing homes. The new rule applies to all nursing homes that receive funds from Medicare or Medicaid. Nursing homes must provide at least 3.48 hours of care per resident per day. This consists of at least 0.55 hours of care from registered nurses and 2.45 hours from nurse aides. A white House press release indicates the regulation will be implemented over time to give nursing homes time to hire additional staff.

The nursing home industry is not happy with this new rule. Mark Parkinson, president of the American Health Care Association/National Center for Assisted Living, said “It is unconscionable that the Administration is finalizing this rule given our nation’s changing demographics and growing caregiver shortage.” Further, “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis. … The Administration has gone ever farther than originally proposed, making these requirements even more out of touch and out of reach.”

The final rule on minimum staffing reports, at 89 FR 40885, “According to the Bureau of Labor Statistics (BLS), in March 2020, there were 3,372,000 staff working in nursing homes and other LTC facilities and an average of 1,319,318 residents per day in nursing homes. Total staffing dropped to a low of 2,961,200 for staff working in nursing homes and other LTC facilities in January 2022, a decrease of approximately 410,000 staff from March 2020. The daily census of residents averaged 1,152,842 per day in nursing homes in January 2022. Workforce challenges may have contributed to the drop in staff, but it appears to have been caused by multiple factors, such as the drop in the number of nursing home residents. The number of staff is improving, as of November 2023 there are 3,216,700 staff working in nursing homes and other LTC facilities, still 155,300 less than March 2020. Facilities averaged 1,201,585 residents per day in November 2023.” Also in the final rule are excerpts from families of residents who supported the rule change with stories of what their loved ones experienced.