long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Taking a Closer Look at Long-term Care Staffing Mandates : Is It Finally Time ?
Currently , the Centers for Medicare & Medicaid Services ( CMS ) requires long-term care facilities to have sufficient staffing to provide adequate care to residents . Unfortunately , the term “ sufficient ” is subjective and according to multiple studies has fallen severely short for what is needed to provide even “ adequate ” care . CMS has proposed new staffing mandates to require a minimum number of registered nurses ( RNs ), licensed practical nurses ( LPNs ), and certified nursing assistants ( CNAs ) based on the number of residents in the facility that would ensure that residents receive a minimum of 4.1 hours of care per day . This new staffing requirement could take effect as early as this spring and has been the topic of heavy debate within the industry .
On the surface this mandate may seem like a no-brainer . Proponents argue that such mandates would ensure that residents receive the best possible care , while opponents suggest that mandates would be too expensive and could lead to unintended consequences . What does a staffing mandate really mean for our industry and is it realistic to implement in the wake of the COVID-19 pandemic ?
Quite simply , in a perfect world , facilities would be able to always have enough caregivers to provide the residents with phenomenal care and attention . Without question or argument , every resident deserves this high level of quality care . Hence , a staffing mandate would be one step closer to ensuring that residents receive this care . Studies have shown that residents who receive more hours of direct care from nurses and other staff members tend to have better health outcomes , including fewer hospitalizations , and lower mortality rates . 1 It ’ s not hard to see the merit in the equation of more caregivers = better care . By mandating minimum staffing levels , facilities would be required to ensure that residents receive the care they need and deserve .
In addition to improving health outcomes , proponents of staffing mandates suggest that such requirements would improve the quality of life for residents . With more staff members available , residents would be more likely to receive prompt attention when they need assistance with activities of daily living or other needs . This could help them maintain a higher degree of independence and dignity , which could contribute to their overall sense of well-being .
While staffing shortages are an ongoing issue within the industry , proponents of this mandate believe that requiring facility to have more staff would improve the high turnover rates . So many facilities struggle to attract and retain qualified staff members , particularly nurses . Overworked and understaffed nurses and other staff members struggle to provide high-quality care given the often unrealistic and sometimes dangerous working load , which leads to burnout and unsustainable working conditions . With a solid and strong workforce in place , staff would be better supported and their workloads more manageable thereby creating a more desirable working environment .
Despite all these positive aspects a mandate would provide , is it truly that simple ? Is it realistic at this time when staffing is already at
an all-time low ? Opponents of staffing mandates suggest that such requirements would be too expensive for companies to implement . As we know , many facilities are already struggling financially , and mandating additional staff members could exacerbate this problem .
The higher costs associated with staffing , could lead to higher costs for residents and their families . Facilities that are required to maintain higher staffing levels may need to raise their fees to cover the additional expenses . This could make care even less affordable for individuals and families , many of whom are already struggling to pay for the care .
The financial consequences for a facility could be grave given the significantly low Medicaid reimbursement rates . This may lead to more facilities closing which could lead to a shortage of nursing home beds in some areas , potentially making it more difficult for individuals and families to find suitable care options . New York state is currently experiencing the consequences of a minimum staffing requirement of 3.5 resident hours per day 2 , which is leading to families finding it harder to place their loved ones in a facility of choice . It is further creating a bottleneck for hospitals as patients are having to wait longer for a post-acute bed , thereby delaying critical medical care services for those in need .
There already exist a shortages of nursing staff given the consequences of the COVID-19 pandemic . Therefore , where are facilities going to get staff ? They may have to continue investing in agency nurses who are far more expensive , may not be as invested in the residents , and do not provide continuity in resident care .
This debate is a complex one , with both pros and cons to consider . While on paper and what research studies have demonstrated , minimum staffing requirements seem simple and the solution that is needed . I will be the first to say that the staffing levels we now have are not sufficient . I see it every day when I go onsite into facilities across the country . I see worn out staff that are exhausted and burned out with their unrealistic workloads . They need help . They deserve it and the residents deserve high quality of care . So , let ’ s take the pros and cons and use them to roll out staffing requirements over time that will support not collapse this already fractured system .
Buffy Lloyd-Krejci , DrPH , CIC , LTC-CIP , is a leading authority on infection prevention in the long-term care industry . Her firm , IPCWell , delivers in-person gap analysis , training , and support to nursing homes across the country .
References :
1 . Nursing Home Staffing Standards in State Statutes and Regulations . National Conference of State Legislatures . 2019 .
2 . Stulick , A . ( 2023 , January 27 ). Skilled Nursing News . Retrieved from https :// skillednursingnews . com / 2023 / 01 / cautionary-tale-staffing-mandate-collides-withnursing-home-labor-crisis-and-referral-bottleneck /#:~: text = The % 20rule % 20applies % 20 to % 20certified % 20nursing % 20assistants % 20 % 28CNAs % 29 % 2C , must % 20be % 20 provided % 20by % 20an % 20