White House Issues Final Nursing Home Minimum Staffing Rule

April 22, 2024- This morning, the White House issued a statement on the Final Nursing Home Minimum Staffing Rule, which will require nursing homes receiving federal funding to deliver 3.48 hours of daily direct care per patient. Specifically, this includes .55 hours of care delivered by registered nurses per resident per day and 2.45 hours of care delivered by nursing aides per resident per day, with the remaining time not defined. The rule also requires an onsite Registered Nurse (RN) 24 hours a day, seven days per week.

The statement specifies, “This means a facility with 100 residents would need at least two or three RNs and at least ten or eleven nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the minimum staffing standards. Many facilities would need to staff at a higher level based on their residents’ needs.”

The White House statement verbiage allows for the requirements of this rule to be introduced in phases, with longer timeframes for rural communities, to allow time to adjust staffing and recruit for positions. The White House also reported that limited, temporary exemptions will be available for both the 24/7 registered nurse requirement and the underlying staffing standards for nursing homes in workforce shortage areas.

CMS, in its proposed rule, has estimated a cost of $4 billion annually, but other industry experts estimate the cost to be significantly more. The agency has so far offered limited funding for its staffing initiative. A one time $75 million allotment is proposed that could potentially be used to market nursing home jobs and create financial incentives to help nurse aides pay for training, but will likely not be adequate to offset expected costs.

Nursing home provider organizations and industry leaders have significant and ongoing concerns, including:

• The current healthcare climate reflects historic staffing losses, with unprecedented numbers of caregivers leaving the industry.
• An even greater concern for rural and underserved homes.
• Hundreds of thousands of caregivers and nurses are needed to fulfill the requirements at a time when staffing shortfalls are at an all-time high.
• Specification of RNs over Licensed Practical Nurses (LPNs) would require a significant staffing shift for many nursing homes.
• A “one size fits all” approach to staffing that may not best serve the industry.

“It is unconscionable that the Administration is finalizing this rule given our nation’s changing demographics and growing caregiver shortage,” Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living, said in a statement Monday morning. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis. 

There are active bills in both houses of Congress that could block the rule. Industry leaders, nursing home administrators, and lawmakers seem to be aligned in a desire to find a better, more workable solution to concerns about the quality of care for this country’s seniors.

For additional information, see the White House fact sheet.

Powerback will continue to monitor this important legislation and focus advocacy efforts on supporting our partners and the residents they serve.

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