Safe Staffing Mandate

The nursing home staffing crisis is a call to action for safe staffing levels in long-term care facilities for quality care for older adults. Nursing home residents are suffering because their facilities do not have adequate numbers of staff to care for them.

Without safe staffing, the understaffing will continue with devastating consequences for residents, families, and staff. Too often, low staffing persists because it saves facilities money and increases owners’ profits. Many such nursing professionals are hoping facilities will help them spend more time with patients, and prioritize staffing support over higher salaries.

The issue of nurse staffing and “[t]he adequacy of a nursing home’s staffing is the measure most closely linked to the quality of care residents receive.”

A congressionally mandated study issued in 2001 found that 4.1 hours per resident day (HPRD) of nursing staff time were needed to prevent avoidable harm to residents and to meet requirements of the 1987 Nursing Home Reform Act.

CMS’s nurse staffing rule proposes a standard of 3.0 HPRD (.55 HPRD for RNs and 2.45 HPRD for nurse aides). The proposed rule does not specify time for licensed practical nurses (LPNs), who provide more of the licensed nursing care in nursing facilities than RNs.

CMS also asked for public comment on a possible 3.48 HPRD standard that could include LPNs.

The Medicaid and CHIP Payment and Access Commission (MACPAC) refutes complaints that facilities do not receive sufficient funding to hire more nurses. In 2023, in both an Issue Brief and Report to Congress, MACPAC reports insufficient evidence that Medicaid rates for nursing homes are inadequate, citing the lack of information about how much total Medicaid funding facilities actually receive, how much they divert to related parties they own and control, and how they spend their public reimbursement.

Understanding the ownership of nursing homes and how public funds are utilized could help in the pursuit of staffing and other reforms. Transparency in these areas could ensure that additional resources are channeled into the nursing home sector in a manner that promotes the highest quality of care for residents.