More Staff Equals Better Quality Care for Nursing Home Patients

Oct 20, 2023

There are over 1.5 million Americans in long-term care nursing facilities today. That number is projected to grow as the elderly population explodes over the coming two decades. In fact, people 65 and older are the fastest growing age segment in the United States population, yet despite the coming tidal wave of aging people, there is very little attention paid to how the nation will provide for the increased demand for health and personal care services. 

Whether an aging person receives services in their home or in a long-term care facility, the care provided should be high quality, meet the individual’s needs, and enhance their quality of life. But all too often, we fail to meet this standard despite billions of dollars of investment that both tap public resources and deplete people’s lifetime savings and assets. 

As we saw during the most intense periods of the COVID pandemic, the crisis is acute in nursing homes and long-term facilitated where more than 200,000 nursing home residents and workers died—around one-fifth of all COVID-19 deaths in the United States—because of short-staffing, poor protocol, and lack of attention to the real time needs of the residents. The phenomenon of short-staffing in nursing facilities didn’t start with COVID, but the tremendous loss of life during the pandemic put a spotlight on problems with the lack of oversight, accountability and consistent standards that characterize this sector. 

Despite the fact that the nursing home industry receives nearly $100 billion from American taxpayers every year, far too many facilities continue to provide substandard care. During this year’s State of the Union address, President Biden committed to improving the quality of long-term care in nursing homes with federal minimum staffing requirements, increased oversight and enforcement, and expanded workforce initiatives to recruit and retain staff. These improvements would offer much needed support for health care workers, improved care for residents and better protection for both. 

The Department of Health and Human Services (HHS) recently proposed new regulations that would take a critical step in finally addressing the needs of nursing home residents and their families. These new regulations would create a federal floor for staffing, ensuring that nursing home owners could no longer slash staffing to unsafe levels. The proposal would also require every facility to have a registered nurse on site 24/7, to have a minimum number of registered nurses and nurse aides to help provide routine care, and to staff according to patient needs based on a robust assessment of the facility’s residents. These proposals don’t go nearly far enough, but given that currently no minimum standard exists and that nursing home operators answer to no one on staffing, it would be a huge improvement and lay the foundation for even more.

Under the new HHS rules, residents would receive a minimum of 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, exceeding existing standards in nearly all states. According to the Centers for Medicare & Medicaid Services (CMS), 75% of nursing home facilities would need to hire more nurses and nurse aides to meet even this very modest requirement. Additional analysis from KFF Health News indicates that number could be even higher, over 80%.

These new rules are long overdue. Not only does short staffing hurt patients, it increases the risk of injury for workers and drives more and more people out of care-giving professions. Providing care to elderly patients or people with disabilities who have mobility challenges, chronic disease, cognitive decline, dementia or other common conditions requires patience, skill and physical dexterity. Workers should be fairly compensated, have safe working conditions and basic protections including whistle-blower protections that also help patients. 

The for-profit nursing home industry vociferously opposes these minimum staffing standards, insisting there’s no way to meet these standards. But the reality is that the non-profit nursing home industry is, on average, providing staffing that already exceeds CMS proposed staffing levels. This raises the question of whether for-profit nursing homes could, in fact, meet the new standard if they spent more money on staffing and less on profits. 

Right now, any member of the public has an opportunity to weigh in on this debate because CMS is accepting comments on the proposed rules until the November 6th deadline. Anyone–residents in nursing homes, health care workers, family members, concerned advocates, service providers can submit a comment that describes why they support this important first step. Remember that once a comment is submitted, it will become part of the public record. 

Currently, the nursing home industry is weighing in very heavily against the proposed rules in an effort to protect the current status quo where nursing homes don’t have to meet any staffing standard. It’s up to all of us to keep fighting for better care and urge HHS and CMS to forge forward on the new rule.