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New York nursing homes are gearing up for the federal government’s new staffing mandate, but they say a lack of funding and staff shortages make it unlikely that they’ll be able to comply.
The Biden administration finalized a rule Monday that requires all nursing homes to provide all residents with nearly three and a half hours of direct care each day. The rule requires two and a half of those hours to come from a certified nurse assistant, and a half an hour to come from a registered nurse, who can do more complicated tasks like administering medications or assessing a patient’s mobility. Nursing homes can hire certified nurse assistants, registered nurses or licensed practical nurses to provide the remaining half hour of care required.
The federal nursing home staffing rule is not all that new for New York’s facilities, which have been subject to a state law requiring them to staff at similar levels since 2022. Although the federal rule reinforces levels of care that are already mandated in New York state, nursing homes say they’re still not likely to meet it – evident by the fact that only half of homes statewide are currently in compliance, according to a Crain’s analysis of federal data.
James Clyne Jr., president of nonprofit nursing home industry group LeadingAge New York, said that a majority of New York nursing homes are not meeting the state mandate due to existing staffing shortages and a lack of funding to fill the gaps. Neither the state mandate nor the new federal rule are tied to funding to help nursing homes hire staff – a challenge that makes compliance with both nearly impossible, he said.
“If they want a staffing mandate, they have a responsibility to pay for it,” Clyne said. “Otherwise it’s just wishful thinking.”
The Centers for Medicare and Medicaid Services first proposed a nursing home staffing mandate in September, following increased attention on the poor conditions in nursing homes revealed by the Covid-19 pandemic. The federal government’s draft rule required nursing homes to provide a minimum three hours of resident care per day, sparking criticism from patient advocates and medical experts who said more care is needed to prevent patient harm.
The final rule not only adds an additional half an hour of direct care to the requirements, it also requires nursing homes to have a registered nurse on the premises at all times. Additionally, it includes a requirement for more assessments at facilities to determine whether the acuity levels of patients require even more staff.
Richard Mollot, executive director of the Midtown-based patient advocacy group Long-Term Community Care Coalition, said that the requirement to have a registered nurse onsite at all times is a win for patient care. But the overall staffing mandate, he said, is inadequate as it falls below four hours of care – a staffing level identified in a 2001 government-funded study as the bare minimum to avoid patient harm.
“The rule validates something that is really too low,” Mollot said. “Too often in these circumstances, the floor becomes the ceiling.”
Even at lower levels, the current mandates still pose barriers for nursing homes, Clyne said. The latest budget deal included $285 million for nursing homes – not nearly enough to cover the costs of care, let alone hire additional staff to meet mandates, he added.
Nursing homes are also not clear on whether the federal rule will take precedence to New York’s current mandate, but Clyne said that the layered laws will likely result in facilities juggling the separate clinician-specific ratios of each rule.
Erin Clary, a spokeswoman for the Department of Health, said that the agency is reviewing the new federal rule and cannot comment further at this time.
New York’s staffing law went into effect last year, but the state implemented a delayed rollout because of severe staffing shortages in all counties across the state. Clyne’s organization filed a lawsuit against the state claiming that the mandate was not constitutional, but that lawsuit was thrown out by a judge in December and the mandate still stands.
The federal government’s nursing home mandate will be implemented over the next two years. Rural facilities and smaller homes will have additional time to put the mandate into practice.
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Amanda D'Ambrosio , 2024-04-24 11:33:05
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