Nursing Home Staffing Mandate Finalized by Biden Administration, Faces Industry Opposition

The Biden administration, through Vice President Kamala Harris, announced on Monday the finalization of the first-ever minimum staffing rule for nursing homes.

The mandate requires nursing homes receiving Medicare and Medicaid funding to provide a minimum of 3.48 hours of nursing care per resident per day, which includes specified periods from registered nurses and nurse aides. This translates to a facility with 100 residents needing at least two or three registered nurses and at least 10 or 11 nurse aides per shift, along with additional nursing staff, according to a White House fact sheet.

Additionally, nursing homes must have a registered nurse present at all times. The implementation of this rule will occur over three years, with rural communities having up to five years. Temporary exemptions will be considered for facilities facing workforce shortages, provided they demonstrate sincere efforts to hire.

The rule, first proposed in September, aims to address chronic understaffing in nursing homes, which can lead to substandard or unsafe care, according to the White House.

The Department of Health and Human Services (HHS) estimates that 75% of nursing homes will need to hire additional staff, including 12,000 registered nurses and 77,000 aides, to meet the daily care requirements. Just over 22% will require additional registered nurses to fulfill the around-the-clock staffing mandate.

The American Health Care Association, representing over 14,000 nursing homes and long-term care facilities, strongly objected to the staffing proposal, citing existing challenges in filling open positions. The association estimated that meeting the proposed mandate would require hiring more than 100,000 additional nurses and aides at an annual cost of $6.8 billion.

Despite industry pushback, HHS Secretary Xavier Becerra emphasized the importance of prioritizing safety and quality care for nursing home residents. Becerra noted that accommodations would be made for facilities encountering workforce challenges, including grant assistance for hiring.

Some consumer advocates, while acknowledging the rule as a step forward, emphasized that more care beyond the minimum hours is needed for residents’ health and safety.

The Biden administration’s effort to implement the staffing rule has garnered mixed reactions in Congress, with bipartisan support for legislative measures that could impede the rule’s finalization. However, Democratic lawmakers like Sen. Elizabeth Warren have advocated for strengthening the rule to enhance patient care and worker conditions.

In addition to the staffing rule, the administration announced a final rule to enhance access to home care services for elderly and disabled Americans, aiming to improve caregiving quality and worker wages by ensuring at least 80% of Medicaid payments for home care services go toward workers’ wages.