New Staffing Standards for Long-Term Care Facilities

For anyone who has a loved one in a long-term care (LTC) facility or resides in a LTC themselves, may be concerned with the quality of care that residents receive in these facilities. While many think of LTC facilities as only caring for the elderly, these facilities often provide care to individuals with ongoing health issues or disabilities who are unable to care for themselves. There have been numerous studies conducted that show that the quality-of-care residents receive is directly correlated with staffing levels. Unfortunately, COVID-19 not only highlighted the concerns and issues associated with understaffing in LTCs, but it also exacerbated them. There are approximately 1.4 million individuals who reside in Medicare and Medicaid LTCs that are affected by reduced quality of care due to understaffing.

In response to this ongoing issue, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule on September 1, 2023, titled Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting (CMS 3442-P). The purpose of the proposed rule is to establish minimum staffing standards. While establishing minimum standards for staffing – it would also bolster support for staff in LTCs that is essential for providing safe and quality care to the residents of these facilities. The proposed rule would protect the health and safety of residents and ensure that their needs, along with the staff’s needs, are met.

The proposed rule lists three new staffing requirements, which could come into effect if the rule is implemented in its current form. First, the rule would require that a registered nurse be on site twenty-four hours a day, seven days a week to ensure that all residents receive adequate care in accordance with their individualized resident care plans. Second, the rule would require new individual minimum staffing type standards for registered nurses and nursing aides. Specifically, a facility would be required to provide 0.55 registered nurse hours per resident day (HPRD) and 2.45 nursing aide HPRDs. To comply, hours per resident day is defined as “staffing hours per resident per day which is the total number of hours worked by each type of staff divided by the total number of residents as calculated by the CMS.”

CMS would stagger the implementation of the staffing requirements to allow for facilities to have adequate time to prepare for compliance with the proposed rule. Three years after publication of the rule all urban LTCs would have to meet the proposed staffing requirements. However, because of the specific hardships of staffing in rural areas the implementation timeline would differ slightly. In rural areas – three years after the rule is published facilities would have to comply with the requirement for a registered nurse to be on site twenty-four hours per day, seven days a week. However, rural LTCs would have five years to comply with the HRPD requirements for registered nurses and nursing aides.

The third requirement would promote public transparency of State Medicaid agencies. This last requirement would place an obligation on State Medicaid agencies to report the percentage of payments in nursing facilities and intermediate care facilities for individuals with intellectual disabilities for Medicaid-covered services. CMS believes that the implementation of all three of these proposed requirements would better ensure the health and safety of the 1.4 million residents in LTCs across the country. The public comment period is open until November 6, 2023.

If you or a loved one are a resident at a Long Term Care Facility or if you operate a Long Term Care Facility and will be impacted by the Center for Medicare and Medicaid Services proposed rule and you wish to learn more, please contact Jennifer L. Gross at jennifer@crlaw.biz or any of the attorneys at Cooper & Riesterer, PLC

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