CMS Proposed Minimum Staffing Requirements Could Cost $10B Annually

Health care worker speaking with residents in a long-term facility.

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Nursing homes and long-term care (LTC) facilities need to increase staffing minimums at the federal level and that expansion might cost $10 billion dollars annually according to The American Health Care Association and National Center for Assisted Living (AHCA/NCAL). The AHCA/NCAL published a new report titled, “Staffing Mandate Analysts In-depth Analysis on Minimum Nurse Staffing Levels and Local Impact” released from accounting and consulting firm CLA (CliftonLarsonAllen LLP). The report was in response to the Centers for Medicare and Medicaid Services’ (CMS') report released in April 2022, with the proposed rule for the skilled nursing facilities per diem prospective payment system, payment updates for Federal Fiscal Year 2023. In the proposed rule, CMS is seeking input regarding the establishment of a minimum staffing requirement for LTC facilities.

The report says that the funds would hire 187,000 nurses and nurse aids at 4.1 hours per resident day in 94% of LTC facilities to comply with the requirement in caring for more than 900,000 residents.

However, if facilities are required to meet this increased hiring standard and they are not able to comply, 205,000 or 18% of residents could be displaced. The facilities would have to decide how to reduce their census to meet the minimums.

The press release says that “this analysis covers RN, LPN, CNAs. “RN includes Director of Nursing, RN with administrative duties, and RN/ LPN includes LPN with administrative duties and LPN/nurse aide includes CNA, aides in training, and medication aides/technicians.”

The situation is not new, but it is getting worse with the work the staff is required to do has doubled since the start of the pandemic. Already more than half of all LTC providers say that since January 2022, their overall workforce condition has deteriorated. This proposed increased staffing requirement will exacerbate the situation. However, the LTC staff agree that the residents deserve the best care, and the increased staff would provide that support.

Studies show that with increased staff, residents have better outcome and more fulfilling lives, but the pay for LTC workers is far lower than hospitals or other facilities, and hiring and keeping workers is a challenge.

“Every nursing home wants to hire and develop more caregivers, but they can’t do it alone. An enforcement approach will not solve this long-term care labor crisis,” Holly Harmon, RN, AHCA’s senior vice president of quality, regulatory, and clinical services said in the press release. “We urge the Administration and Congress to put forth meaningful aid and policies that will help us recruit and retain the dedicated caregivers our nation’s seniors deserve.”

Mark Parkinson, president and CEO of AHCA, concurred with Harmon as noted in the press release. "This report makes it crystal clear that increasing staffing standards in nursing homes requires substantial and consistent government resources. Even then, nursing homes would have the impossible task of finding another 187,000 nurses at a time when vacant positions sit open without applicants for months on end. The unintended consequences of this sort of unfunded mandate would be devastating to hundreds of thousands of vulnerable residents who could be forced out of their nursing home.”

Even before the COVID-19 pandemic, the LTC industry was already facing an unprecedented staffing crisis because of the nationwide nursing shortage. Disproportionately, nursing homes have lost more workers than any other health care segment during the pandemic, with the number reaching over 200,000. Further, more than 250,000-450,000 workers are expected to be needed (but come up short) by 2025. This proposed staffing requirement is not going to singlehandedly fix a broken system.