White House Announces Nursing Home Minimum Staffing Rule Finalized

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The nursing home minimum staffing rule has been finalized, impacting all nursing homes that receive federal funding through Medicare and Medicaid, according to an announcement from the White House.

The rule mandates a minimum of 3.48 hours per resident per day of total staffing, with specific allocations for registered nurses (RN) and nurse aides.

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For every resident per day, the staffing requirements include 0.55 hours from registered nurses and 2.45 hours from nurse aides, according to a fact sheet released by the White House this morning. This translates to facilities with 100 residents needing a minimum of two to three RNs and ten to eleven nurse aides per shift, along with two additional nurse staff members, who could be registered nurses, licensed professional nurses, or nurse aides.

“Many facilities would need to staff at a higher level based on their residents’ needs,” the White House stated. “It will also require facilities to have a registered nurse onsite 24 hours a day, seven days a week, to provide skilled nursing care, which will further improve nursing home safety.”

The Centers for Medicare & Medicaid Services (CMS) had not released the full text of the finalized version of the rule as of early morning on April 22.

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Since the minimum staffing proposal first was issued last fall, the nursing home industry has pushed back against many of its provisions. This morning, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) posted on X that, “This unfunded, one-size-fits-all approach will only worsen seniors’ access to care.”

An official statement will be forthcoming, the AHCA post stated.

The Senior Care Pharmacy Coalition (SCPC) released an official statement registering the organization’s opposition to the rule, echoing many of the concerns raised by long-term care providers and their professional associations in the lead-up to the rule being finalized.

“This burdensome mandate will have significant implications on seniors’ access to quality care across LTC settings. Ultimately, it will limit access to nursing facility care for Medicare and Medicaid beneficiaries, undermine overall quality of care and services for LTC facility residents, and threaten the financial viability of LTC facilities as well as LTC pharmacies,” said Alan Rosenbloom, president and CEO of the SCPC. “At a time when our health care industry is already facing a multitude of challenges, including significant issues in finding an available workforce, we should be looking for innovative solutions to improve quality, accessible and affordable care, for all patients.

The nursing home staffing rule stems from a comprehensive package of intended nursing home reforms that the White House first released in 2022. The Centers for Medicare & Medicaid Services (CMS) subsequently undertook a study to determine the efficacy of implementing various staffing thresholds; the study, conducted by Abt Associates, came back with mixed findings.

“In February 2022, the President wisely determined to base any staffing ratios on research,” Ruth Katz, senior vice president of policy at LeadingAge, said at the time. “The report he commissioned said there is no single staffing level that would guarantee quality care. Policy should be based on evidence.”

This is a developing story and will be updated.

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