Federal Minimum Staffing Rules for Nursing Homes

The U.S. Centers for Medicare and Medicaid Services finalized a rule on April 22 requiring nursing homes that receive Medicare and Medicaid funds to provide at least 3.48 hours of nursing care per resident per day.

Response from Laurie Facciarossa Brewer, New Jersey's Long-Term Care Ombudsman:

• Minimum staffing requirements for nursing homes represent a positive step, and I applaud the federal government for instituting them. Understaffing is the root of most problems faced by nursing home residents. Call bells go unanswered for too long in understaffed homes. Meals may be delayed or missed. Residents may not be given medications on time. They may be unable to get assistance going to the bathroom. As a result, some residents end up soiling themselves or sustaining falls and injuries trying to get to the bathroom themselves. I welcome any effort to bolster staffing and alleviate these concerns.

  This is especially important as we see the increased corporate consolidation and investor ownership of nursing homes. The new requirements will help curb the impulse of some providers to prioritize profits over people.

  Yet the rules are no panacea.

  On one hand, the requirement to have a registered nurse (RN) present 24 hours a day is a significant benefit. Many nursing homes already do this, and the available research shows that having RNs on-site clearly translates to better care.

  At the same time, the nursing care standards do not go far enough. The federal rule requires 3.48 hours of nursing care per nursing home resident per day, with at least 0.55 hours of RN care and 2.45 hours by nurse aides. I believe this standard is a far cry from what residents actually need and deserve. At this level, residents may still go without needed care.

  Research from two decades ago concluded that nursing home residents need more than four hours of nursing care per day, and more recent studies show even more hours are needed.

  As advocates for long-term care residents, my staff and I will continue working at the state and federal levels to support efforts toward increasing these standards.

  I also believe we need a comprehensive state effort to fundamentally remake our long-term care system. We need to expand state policies and investments that enable people to age in place and avoid nursing homes. We need to reimagine nursing homes to encourage smaller, home-like places that stand in stark contrast to the large, institutional nursing homes we have now. We also need to promote better compensation and support for long-term care staff so we can recruit and retain committed, compassionate professionals to the field.

  Again, today's federal rule is a welcome first step. But we still have a long journey ahead of us.

About the New Jersey Long-Term Care Ombudsman

The Office of the New Jersey Long-Term Care Ombudsman is an independent state agency dedicated to the mission of advancing the rights, dignity, and self-determination of adults living in long-term care, including nursing homes, assisted living, and residential health care facilities. Learn more.