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Sept 1 [press release] -- Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a proposed rule that seeks to establish comprehensive staffing requirements for nursing homes—including, for the first time, national minimum nurse staffing standards—to ensure access to safe, high-quality care for the over 1.2 million residents living in nursing homes each day. This proposed rule builds on the President’s historic  Action Plan for Nursing Home Reform launched in the 2022 State of the Union.

Today’s action is one among many advanced by the Biden-Harris Administration to build a long-term care system where all older Americans can age with dignity, where people with disabilities can receive high quality services in the setting of their choice, where family caregivers are adequately supported, and where there is a pipeline of direct care workers into good-paying jobs with the free and fair choice to join a union. . . .

Under CMS’s proposal, nursing homes participating in Medicare and Medicaid would be required to meet specific nurse staffing levels that promote safe, high-quality care for residents. Nursing homes would need to provide residents with 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. CMS estimates approximately three quarters (75%) of nursing homes would have to strengthen staffing in their facilities. As the long-term care sector continues to recover from the COVID-19 pandemic, the proposed standards take into consideration local realities in rural and underserved communities through staggered implementation and exemptions processes.

In addition, nursing homes would also be required to ensure a registered nurse is on site 24 hours per day, 7 days per week and to complete robust facility assessments on staffing needs. Facilities would continue to be required to provide staffing that meets the needs of the individual residents they serve, which may require higher levels of staffing above the proposed minimum standards.  

CMS also proposes to require states to collect and report on compensation for workers as a percentage of Medicaid payments for those working in nursing homes and intermediate care facilities. These policies build on CMS’ recent proposals to support compensation for direct care workers in home- and community-based settings and to publish Medicaid data on average hourly pay rates for home care workers. This enhanced transparency will aid efforts to support and stabilize the long-term care workforce across settings. The Biden-Harris Administration remains committed to strengthening access to high-quality long-term care both at home, in the community as well as in nursing homes and other facilities.

Additionally, CMS announced a national campaign to support staffing in nursing homes. As part of the HHS Workforce Initiative, CMS will work with the Health Resources and Services Administration (HRSA) and other partners to make it easier for individuals to enter careers in nursing homes, investing over $75 million in financial incentives, such as scholarships and tuition reimbursement. This staffing campaign builds on other actions by HHS and the Department of Labor to build the nursing workforce.

“Wages are an important part of job quality and drive challenges in recruitment and retention of direct care workers. Our research shows that in many places these workers can earn higher wages doing other entry-level work,” said Miranda Lynch-Smith, Senior Official Performing the Duties of the Assistant Secretary for Planning and Evaluation.

More than 500,000 direct care workers provide care in nursing homes, assisting residents with daily tasks, such as bathing, dressing, mobility, and eating. This work, performed primarily by women of color, is significantly undervalued. Direct care workers across long-term care settings earn low wages, rarely receive health and retirement benefits, and experience high injury rates. Improving working conditions and wages will lead to improvements in the recruitment and retention of direct care workers and enable nursing staff to provide safer care.  

Findings published by the Office of the Assistant Secretary for Planning and Evaluation show that wages for direct care workers trail other entry-level jobs. In 2019, median wages for nursing assistants were lower than the wages of other entry level jobs in 40 states and the District of Columbia. As an example, the median wage for nursing assistants in Louisiana is $10.90 per hour, compared to $13.41 for other entry-level positions. This is despite the significant demands of direct care jobs and their essential role in meeting the long-term care needs of older adults and people with disabilities.

ASPE Direct Care Worker Wages: https://aspe.hhs.gov/reports/dcw-wages
Fact sheet: https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid
Proposed rule: https://www.federalregister.gov/d/2023-18781
Press release: https://www.cms.gov/newsroom/press-releases/hhs-proposes-minimum-staffing-standards-enhance-safety-and-quality-nursing-homes

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