courtesy of kffhealthnews.org
The Battle Begins
The Biden administration is pushing for regulatory changes that would require nursing homes to increase their staffing. However, the biggest question remains: do these homes have the funds to hire and retain more nurses and aides?
The proposal has sparked a fierce lobbying battle between nursing homes and patient advocates. Over 22,000 comments have already been filed with the Centers for Medicare and Medicaid Services (CMS), with the deadline for public comments approaching.
Official nursing home financial records reveal that more than 40% of homes reported losses in 2021. The industry argues that it cannot afford higher payrolls. Instead of providing more funding through Medicare and Medicaid, CMS has proposed exempting financially struggling homes from higher staffing requirements.
Concerns and Controversy
This exemption has caused concern among patient advocates and many nurses and aides. The fear is that exempting financially struggling homes could lead to more financial manipulation within the industry, where owners appear poor while diverting money for personal gain.
One common trick used by nursing home owners involves setting up separate companies to shift the financial burden away from the licensed home. These companies charge the nursing home fees determined by their common owner, while only the licensed home is required to disclose its finances to the government.
Tracking Spending and Transparency
The CMS proposal would require states to track how much money each home spends on direct care billed to Medicaid. This could potentially uncover homes that are shortchanging employees and patients. However, there are concerns that industry accountants may find ways to circumvent these requirements, and there is a lack of transparency regarding the allocation of funds from Medicare, private insurance, and out-of-pocket revenue.
Current Staffing Requirements
Under existing federal rules, nursing homes are only required to have at least one registered nurse working for eight consecutive hours each day, and at least one licensed nurse on duty at all times. The new proposal would require each nursing home to have:
- Enough staff to provide a minimum of 3.5 hours of direct care per resident per day
- A registered nurse on duty for at least 75% of the time
- A licensed nurse on duty 24/7
The CMS has also suggested the possibility of adding an additional requirement of one nurse or nurse aide for every seven residents.
Advocates Demand More
Patient advocates argue that the nursing home industry has sufficient funds to increase staffing levels. They are calling for staffing levels that exceed the CMS proposal in order to provide the highest quality of care. Advocates are demanding at least one nursing home worker for every six residents, based on a 2001 CMS study that concluded it would result in the best care. However, CMS did not model this scenario when drafting its proposal, angering proponents of greater staffing.