WASHINGTON — The federal government has proposed new staffing rules for nursing homes — including requiring registered nurses to be on site 24 hours a day — a proposal that has drawn the support of Pennsylvania’s two U.S. senators but opposition from the state’s nursing home industry.
The Centers for Medicare and Medicaid proposed in September to establish minimum standards for nursing care, including more than a half-hour of care from a registered nurse and almost 2 1/2 hours from a nurse aide every day.
While U.S. Sens. Bob Casey and John Fetterman, D-Pa., endorsed the proposal, more than two dozen other senators — both Democrats and Republicans — said it would hurt facilities in rural areas. And Pennsylvania’s nursing home association said the proposed rule would exacerbate a shortage of trained health care workers.
The rules would affect nursing homes that participate in the Medicare and Medicaid programs, which serve more than 1.2 million residents nationally. In Pennsylvania, the state’s nursing homes have about 65,600 residents, with Medicaid covering the care for around 44,000 of them.
Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, said the proposed rule is “an important first step to propose new staffing requirements that will hold nursing homes accountable and make sure that residents get the safe, high-quality care that they deserve.”
CMS estimated that the new rules would require almost three of every four nursing homes to increase staffing. Some nursing homes would have to increase staffing over the minimum required levels in order to meet the needs of their residents.
“When facilities are understaffed, residents suffer,” Health and Human Services Secretary Xavier Becerra said. “They might be unable to use the bathroom, shower, maintain hygiene, change clothes, get out of bed, or have someone respond to their call for assistance.”
Mr. Casey and Mr. Fetterman joined 12 of their Democratic colleagues earlier this month to urge HHS to move ahead with the rule. Mr Casey chairs the Senate Aging Committee.
“The connection between staffing levels in nursing homes and the safety and quality of care is well-established,” they wrote to Ms. Brooks-LaSure.
Still, more than twice as many senators — 28 — signed a letter to Ms. Brooks-LaSure opposing the rule.
“We are deeply concerned that now is the worst possible time for the United States to establish the nation’s first federal staffing mandate for long-term care facilities,” they wrote. “A one-size-fits-all staffing mandate significantly undermines access to care for patients, particularly in rural communities.”
U.S. Reps. Glenn Thompson, R-Centre, and Mike Kelly, R-Butler, were two of 91 House members, both Republicans and Democrats, who signed their own letter to Mr. Becerra opposing the proposed rule.
“New requirements could lead to limited access for seniors and lead to widespread nursing home closures — particularly in rural communities,” said Mr. Thompson, a former administrator for Susquehanna Health System in Williamsport, a job he left to run for Congress. “As these facilities continue to struggle with ongoing staffing issues, the federal government should avoid prescribing a one-size-fits-all approach to long-term care.”
Also in opposition was the Pennsylvania Health Care Association, the trade group for the state’s nursing homes. Mr. Casey and Fetterman are “clearly out of touch with the realities facing health care in Pennsylvania,” said Zach Shamberg, the association’s president and CEO.
“CMS has proposed a staffing mandate that suggests every person across the country has identical care needs in a long-term care setting — this, after previously stating that a ‘one-size-fits-all’ approach to care is not best,” Shamberg said.
The PHCA and the Hospital and Healthsystem Association of Pennsylvania told CMS in November that their facilities don’t have enough trained staff to meet the new requirements.
“The reality is that despite efforts to recruit a new generation of health care professionals and retain the highly-skilled caregivers valiantly serving our communities, employment trends in health care have rapidly decreased while the need for care has dramatically increased,” the two groups wrote in a letter. “Pennsylvania is one of the oldest states in the nation, and it has also become a state in which access to care is in jeopardy as providers struggle with workforce shortages.”
And the state’s Independent Fiscal Office warned in October that the proposed CMS staffing requirement was one of several factors that “could create more stress on long-term care capacity.”
Federal officials said they would spend more than $75 million in scholarships, tuition reimbursements, and other incentives to get people to work in nursing homes.
Wages are a big part of the problem, according to a federal report. The report issued by the assistant HHS secretary for planning and evaluation found that salaries for direct care aides such as nursing assistants and home health aides often were lower than for other entry-level jobs.
In Pennsylvania, salaries for home health and personal care aides are 79% of the pay given to other entry-level employees in other fields. Nursing assistants in the state receive about the same wages as other entry-level workers, the report said.
“Wages are an important part of job quality and drive challenges in recruitment and retention of direct care workers,” said Miranda Lynch-Smith, a senior official performing the duties of the assistant secretary for planning and evaluation.
