CMS Issues Final Rule Setting New Nursing Home Minimum Staffing Levels

The requirements call for U.S. nursing homes to provide three and a half hours of nursing care per day for every resident, as part of a continuing effort to reduce the risk of nursing home neglect and improve the quality of care.

Federal regulators have issued a long-awaited rule setting new nursing home minimum staffing levels, requiring facilities to provide at least three and a half hours of nurse staffing per day for every resident.

The U.S. Centers for Medicare and Medicaid (CMS) published the final rule for minimum staffing standards for long-term care nursing home facilities on Monday in the Federal Register.

The CMS indicates the final rule aims to hold nursing homes accountable for providing safe and high-quality care. This includes nearly 1.2 million residents living in CMS long-term care nursing facilities.

The new rule enacts comprehensive minimum nursing staffing requirements for CMS-certified nursing homes in the U.S. to reduce the risk of unsafe and low-quality care, which often results in nursing home neglect that negatively affects residents.

New Nursing Home Staffing Requirements

The new standards require a total nurse staffing standard of 3.48 hours per resident day. That must include at least 0.55 hours per resident day of direct registered nurse care and 2.45 hours per resident day of direct nurse aid care.

Nursing home facilities can use any combination of nursing staff, including registered nurses (RN), licensed practical nurses, licensed vocational nurses, or nurse aides, to account for the additional 0.48 hours per resident day to comply.

The final rule also calls for enhanced facility assessments and requires nursing homes to keep an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care.

The CMS indicates the minimum nurse staffing regulations will be implemented in a staggered timeframe over several years and the 24/7 RN requirement to be implemented based on geographic location. It also provides some exemptions for parts of the staffing requirements for qualifying facilities.

Nursing Home Staffing Concerns

The new guidelines stem from long-standing concerns over understaffing in nursing homes. Recent research has shown that insufficient staffing and frequent turnover in nursing homes reduce the quality of care patients receive, and may increase the risk of injuries. Researchers indicate that even a 10% increase in staff turnover can decrease the quality of care patients receive and reduce their functioning.

The COVID-19 pandemic greatly impacted the quality of care nursing home patients received, leading to high death rates, increased rates of infections, and other lapses in patient care.

More than 46,000 public comments were received and taken into consideration while creating the final guidelines for the new regulations for the rule.