This past week The Center for Medicare and Medicaid Services released its final rule for a minimum staffing standard for facilities that accept Medicare and Medicaid payments.
What is the standard?
The new standard requires 3.48 hours per resident per day (HPRD)of nursing coverage. It is further broken down to 0.55 HPRD of direct RN care, 2.48 HPRD of CNA care, and the remaining 0.48 HPRD any mix of LPN, CNA, or LVN care. It also requires an RN on site 24 hours a day, 7 days a week. There is a gradual ramp up of staffing for 3 years in urban areas and 5 years in rural areas.
More staffing means better care, right?
One would believe that simply put the more staff there is the better the care will be. If you have more hands on deck there are more opportunities to help with needed care. Unfortunately this is only true in rare circumstances.
Unfortunately looking at the current and future nursing shortages, not only are there less available workers, but even less quality workers. One of the biggest problems during the COVID years was reliance on staffing agencies to cover for missing employees. Now it is pushing more and more to agencies to be able to achieve a number.
Staffing agency staff more frequently do not have a vested interest in the facility they are working in. They do not work for the facility, they work for the staffing agency.
More frequently the care provided by staffing agencies is barely the minimum, but costs the facility exponentially more. This directly effects the available financial ability to maintain and improve the facility, purchase needed equipment like wheelchairs and beds, and have descent and healthy nutritional menus.
Does an RN automatically give better care than an LPN?
There is an old saying that a doctor that passes their courses is still called a doctor. Having a certain degree does not automatically constitute a better caregiver or more attentive and intelligent nurse. There are some tremendously smart and attentive LPNs out there that can easily out perform many RNs at any time.
Are there better metrics than a staffing minimum to assess care?
Through the Centers of Medicare and Medicaid Services there are some benchmarks called quality measures which directly measure the care and quality of life of a nursing home resident. Would not a combination of some staffing minimum as well as a standard level of quality measurement not be a better guage than a simple number of hours?
Where is the plan to address the shortage of nurses?
So where is the assistance to address the shortage of nurses, both the real numbers now as well as the projected further decline. How is a rural nursing home that has enough trouble now to get and keep good staff going to hire even more just to hit a number?
Without help and increases in availability of workers all these nursing homes will continue to struggle. The only thing they are looking at is punitive penalties due to not meeting the standards.
Why not increase affordable access to nursing degrees and stop payment cuts to allow for a livable wage for CNAs and nurses to actually want to go into the field. Would it not be worthwhile for increased accessibility at community colleges to build a workforce?
What will be the impact of this new standard?
Hopefully more thought and change is added to this basic rule to address the real problems faced by nursing homes. Without intervention and stopping one size fits all mentality, hopefully the small rural nursing homes can survive. Without their survival the only ones being harmed is the seniors that will have even less access to care of any type. And these are the residents they are trying to help.
