New Staffing Rule

Inadequate unsafe staffing is the single biggest contributor to poor quality care in nursing homes, and is a major, recurring issue in South Carolina nursing homes. A new rule from CMS establishes at a national level of a minimum total of 3.48 hours of nursing care per day, among other staffing standards.

Anything below that number is neglect. The number may need to be higher depending on the acuity or needs of the specific resident. CMS says the new staffing standards will improve care for nursing home residents while supporting workers by ensuring there are sufficient staff to manage patients.

The rule states that nursing homes participating in Medicare and Medicaid must provide residents with a minimum of 3.48 hours of nursing care per day. The new staffing standard includes at least 0.55 hours of care from a registered nurse per resident per day and 2.45 hours of care from a nurse aide per resident per day. Interestingly, the proposed 3 hours per day of patient care is substantially below the recommended 4.1 hours per day that a CMS study endorsed.

Additionally, nursing homes in the federal programs will also need to have a registered nurse on-site at all times to provide skilled nursing care to prevent patient safety events.

Requirements will be phased in over five years, with waivers available.  Big win for residents and consumers.

“Consumer Voice recognizes that this is an important first step in ensuring that all residents have their care needs met,” wrote the advocacy group. “However, 3.48 [hours per resident per day] is a minimum and not a ceiling. Federal law requires that each facility have sufficient staff to meet the needs of all residents. Most residents will require care that exceeds the 3.48.”

The establishment and rollout of this minimum clarifies CMS’s ability to fine homes based on their failure to abide by the longstanding and unchanged “sufficient” requirement in the statute.

All this does, really, is create a presumption of inadequacy below 3.48, not a presumption of sufficiency at 3.48 and above.