Understanding the Debate Over Nursing Home Staffing Standards in the US

The Proposed Minimum Staffing Standards: An Overview

The US is currently embroiled in a debate over the proposed minimum staffing standards for nursing homes. The Biden administration, in a bid to improve the quality of care in nursing homes, has proposed that facilities should ensure the presence of a registered nurse on-site at all times and meet explicit levels for RN and nurse aide staffing. This proposal, however, has been met with intense criticism from various stakeholders in the industry and advocacy groups.

Industry stakeholders argue that this rule is an 'unfunded mandate' that could lead to the closure of many nursing homes. On the other hand, advocates insist that these standards are necessary to ensure the health and safety of residents. The debate is further complicated by concerns from lawmakers, particularly those representing rural markets, who believe that the standards might be unattainable for some parts of the country.

The Need for Greater Transparency

Amid this debate, there is a growing demand for greater financial and ownership transparency in the nursing home sector. 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.

The Realities of Meeting the Standards

The proposed staffing standards, while well-intended, present a significant challenge for many nursing homes. Studies show that the majority of nursing homes would not meet the hourly requirements for registered nurses and certified nurse aides as proposed by the Biden administration. However, there are nursing homes, like the Permian Residential Care Center in Texas and Lorien Health Services in Maryland, that are already capable of meeting the new standards. This is largely attributed to factors such as lack of local competition, backing of a nonprofit community hospital, established level pay rates and a low turnover rate.

The Cost of Implementing the Staffing Mandate

The staffing mandate is estimated to cost nursing homes in the US $6.8 billion annually, and those in Georgia alone about $187 million annually. A study found that 76% of Georgia nursing homes are not meeting at least one of the proposed staffing requirements, and less than 1% are meeting all three. If nursing homes can't comply with the requirements, they may have to displace residents, stop accepting patients, or even close facilities. The Biden Administration has announced a plan to invest $75 million in a national nursing career pathways campaign to counteract these challenges, but critics argue that significantly more investment is required.

The Future of Nursing Home Staffing

If the rule is finalized, it would be phased in over three to five years. Critics, however, argue that the extended timeline won't help as the staffing shortage among nurses is predicted to worsen over the next several years. With 100,000 RNs leaving the workforce during the pandemic and another 800,000 intending to leave the profession by 2027 due to stress, burnout, and retirement, the future of nursing home staffing appears uncertain.

Given these challenges, it is clear that a balanced and well-thought-out approach is necessary to address the issue of nursing home staffing. The debate over minimum staffing standards underscores the need for more staff and better data on nursing home ownership and public spending. It is essential for stakeholders to engage in open and constructive conversations to ensure that the highest quality of care is provided to residents of nursing homes across the US.