Less Than One-Third of U.S. Nursing Homes Have Enough CNAs on Staff: Report

Despite nursing home staffing shortages, federal experts say they do not foresee a problem with facilities across the U.S. meeting new requirements.

A new federal report warns that few U.S. nursing homes actually meet the recently updated requirements regarding the number of certified nursing assistants (CNAs) needed in facilities nationwide, putting residents at risk of nursing home neglect and abuse.

The Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) published a nursing home staffing report on June 28, indicating that less than one-third of facilities currently meet nursing home staffing requirements, and estimating the number of new staff positions that are needed for facilities to come into compliance.

In April, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on minimum staffing requirements for CMS-certified nursing homes in the U.S., which are designed to help reduce the risk of unsafe and low-quality care provided to elderly or ill individuals in the U.S.

The new report utilizes Nursing Home Care Compare Data from May 2024, to assess current staffing levels in U.S. nursing homes and compare them to the new staffing requirements. The findings suggest that most U.S. nursing facilities currently meet or exceed two of the three minimum hours per resident day (HPRD) requirements set by the new CMS rule, but indicates that all three are necessary to ensure high quality care is provided to nearly 1.2 million residents in CMS-certified long-term care facilities.

According to the report, 50% of nursing homes met the registered nurse care requirement as of May 2024, and 59% met the overall benchmark of 3.48 HPRD. However, only 30% met the certified nursing assistant (CNA) hour’s requirement, highlighting long-standing staffing retention issues in nursing homes and long-term care facilities.

The analysis found that many facilities will need to add a relatively small number of staff to meet the new standards, estimating that an average-sized nursing home falling short of at least one requirement would need to add between 0.7 and 2 additional staff per shift, depending on the role. Despite some reliance on government data that may not capture 24/7 registered nurse coverage, the report noted that 78% of nursing homes provide at least 24 hours of RN care daily.

Nursing Home Staffing Concerns

Healthcare experts and providers have raised concerns about a nursing home workforce that has not fully recovered from the COVID-19 pandemic. While there have been some positive shifts in the workforce, these changes are not universal across all care worker positions or providers, they have noted.

The COVID-19 pandemic greatly impacted the quality of care nursing home patients received throughout the U.S., leading to high death rates, increased rates of infections, and other lapses in patient care. The Government Accountability Office found that more than 200,000 nursing home deaths were reported throughout the course of the pandemic, due to poor quality of care and neglect from insufficient staffing.

A study conducted by the American Health Care Association (AHCA) revealed that more than 73% of U.S. nursing homes reported they were at risk of closing due to insufficient staffing stemming from the COVID-19 pandemic. The study also found that approximately 60% of the participating nursing homes reported moderate or high staff shortages, and at least 98% reported difficulty hiring staff.

The new CMS guidelines are an attempt to address these and other long-standing concerns over understaffing in nursing homes. Recent research shows that insufficient nursing home staffing and frequent turnover reduce care quality and may increase injury risks. Even a 10% increase in staff turnover can decrease care quality and reduce patient functioning.

Critics of the proposed minimum staffing standards argue that they could result in reduced care for seniors rather than improving it. They argue that the standards do not increase the pool of skilled workers needed by nursing homes to comply with the new federal requirements, indicating that mandating nursing homes to hire additional staff, especially when there is a shortage, is unrealistic.

Opponents further claim nursing homes may be forced to reduce the number of residents or even shut down to meet the staffing requirements, potentially reducing available space for elderly residents across the U.S.