WASHINGTON, D.C. -- In September, the Centers for Medicare and Medicaid services (CMS) issued a proposal to establish comprehensive nurse staffing requirements in long-term care facilities. If the federal proposal is finalized, nursing homes across the country could have to boost staffing levels. 

Some federal lawmakers support the concept, but leaders in the long-term care industry say it would be catastrophic. 

According to CMS, the proposed rule consists of three core staffing proposals that will provide safer conditions for residents and staff while improving the quality of care:  

  1. Minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for Registered Nurses (RNs) and 2.45 HPRD for Nurse Aides (NAs);  
  1. A requirement to have an RN onsite 24 hours a day, seven days a week; and  
  1. Enhanced facility assessment requirements. The proposed rule also includes a staggered implementation approach and possible hardship exemptions for select facilities. 

“The research proves this- when you have an appropriate staffing ratio, you’re going to get better care. We have an obligation to provide quality care in every long-term care setting, every nursing home,” said Senator Bob Casey (D- PA) and Chairman of the U.S. Senate Special Committee on Aging. 

Casey believes minimum staffing standards are the least that can be provided to a generation that has given and sacrificed so much for their nation. 

“Those who fought our wars, who worked in and built our factories and our economy, who taught our children, who gave all of us life and love and a great country, they should be the subject of our concern and our attention when it comes to the care that they're receiving in the twilight of their lives,” said Casey. 

But with a serious staffing crisis, Representative Mike Kelly (R- PA) believes it would be impossible for many facilities to meet the proposed requirements. 

“It is the inability to get more people in there to help out. That makes it really hard. These people work sometimes double shifts,” said Kelly. 

The long-term care industry has been fighting staffing shortages for several years. The COVID-19 pandemic exacerbated several challenges, according to industry leaders like Zach Shamberg, President and CEO of the Pennsylvania Health Care Association. 

“This mandate is completely misguided, and it misses the realities facing long term care and specifically nursing home providers, not just in Pennsylvania, but throughout the entire country,” said Shamberg. “Given our workforce challenges, given the fact that this is an unfunded proposal, it would lead to catastrophic consequences for nursing homes across the country and specifically in Pennsylvania, given that we have the fifth oldest population in the entire country,” Shamberg added. 

Shamberg, whose association represents long-term care facilities and companies across Pennsylvania, says the government needs to invest in long-term care and help develop supportive solutions to build a pipeline of long-term care professionals. 

“We can't expect to introduce mandate after mandate without first developing our workforce and building that workforce pipeline,” said Shamberg. “If we really want to improve quality in nursing homes, number one, we've got to look at the funding, whether it comes from Medicare at the federal level or Medicaid at the state level. We can't expect nursing home providers to do more and more with less and less,” he added. 

Senator Casey and Senator John Fetterman (D- PA) were among several Senate Democrats who signed onto a Nov. 7 letter urging CMS to finalize and implement the proposed staffing standards.