Nursing home industry concerned about new staffing rules proposed by Biden administration 

Rules require new minimum levels of care for patients

By: - September 6, 2023 5:30 am

A health care worker wheels a man down the hallway. Oklahomans are divided over new proposed rules governing nursing homes. (Getty Images) (This image cannot be republished unless you have a subscription to Getty.)

OKLAHOMA CITY — Oklahomans are divided over new nursing home rules that the Biden administration says will bolster safety for residents by increasing the amount of direct care patients receive each day.

Opponents argue that the rules would punish long-term care facilities and exacerbate an already existing health care worker shortage, while supporters contend nursing home reforms are sorely needed.

Arguing that staffing levels are linked to care quality, the Biden administration last week unveiled new proposed rules for nursing homes that care for Medicare and Medicaid patients. The requirements are aimed at boosting the number of nurses and certified nursing assistants by offering more hours of direct care to patients, according to proposed rules from the U.S. Department of Health and Human Services (HHS).

Nursing homes would have to provide residents with 33 minutes of care from a registered nurse per resident per day, and 2 hours and 27 minutes of care from a nurse aide, which exceeds standards in nearly all states, the agency announced. 

The Centers for Medicare and Medicaid Services estimate that up to 75% of nursing homes across the nation would have to increase staffing levels if the rules are finalized. The proposed standards could include exemptions for rural and underserved communities.

The rules still need to be approved after a public comment period, according to a report by USA Today.

Steven Buck, president and CEO of Care Providers Oklahoma, which represents the long-term care industry, said the federal requirement comes as nursing homes across the nation are struggling to recruit health care staff. Now, the new proposed federal rules could make it mandatory to hire even more.

Buck said because the proposed rules do not include the funding needed to hire more nurses, long-term care facilities would be punished.

“We have been sounding the alarm about a staffing crisis in long-term care for years,” Buck said. “In fact, several of our facilities have actually had to close their doors and relocate residents when they were unable to find enough qualified workers.”

The Oklahoma Nurses Association ranked the state at 46th in the nation for nurses per capita. Oklahoma has 712 nurses per 100,000 residents.

Wes Bledsoe, an advocate for nursing home reform and founder of A Perfect Cause, praised the proposed changes.

Bledsoe said nursing home system reform is necessary for progress. He became interested in industry reform after his grandmother died in a nursing home.

“Adding staff will help some, but it is far from the answer,” he said.

Bledsoe said more training should be required in nursing homes for health care workers who face halls full of patients with a wide range of conditions.

“They’re supposed to take care of people who can get up on their own but need a little assistance, all the way up to patients who are quadriplegic,” Bledsoe said.

State Sen. Jessica Garvin, R-Duncan, is a former nursing home administrator. She said nursing homes are struggling to afford increased labor costs since the COVID-19 pandemic.

“Even if you increase staffing ratios, they’re screwed, because they’re not making enough to break even,” she said.

If the rules are finalized, Garvin said it would likely mean nursing homes would fill up on private pay patients instead of Medicare and Medicaid patients. The latter two pay lower rates for care.

“Now you’ve just created inequity where their facilities are caring for people who have private pay because they can charge them more versus what the state pays for Medicaid,” she said.

A May survey from AARP found 89% of Democrats and 74% of Republicans said they’d be more likely to vote for candidates who support minimum staffing requirements in nursing homes.

The proposed rule is long overdue, said Megan O’Reilly, AARP vice president for federal health and family issues.

“It is unconscionable what so many people experience in nursing homes and the lack of adequate staffing and care,” O’Reilly said in a statement. “The death and devastation we witnessed over the last three years has been a national tragedy and highlighted the existing shortcomings in nursing home standards.”


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Mindy Ragan Wood
Mindy Ragan Wood

Mindy covers the legislature for Oklahoma Voice. Her areas of focus include infrastructure, municipal government policies, and human services with an emphasis on the needs of intellectually vulnerable and physically challenged adults.