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The Biden administration finalized on Monday the first-ever minimum staffing rule at nursing homes.
All nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift.
Plus, nursing homes must have a registered nurse onsite at all times. The mandate will be phased in over three years, with rural communities having up to five years.
Not only beds, but quite a few facilities have shut down. There is pressure to bring in more workers from overseas but there is also strong pressure to decrease the level of immigration overall because of the acute housing crisis. Aged care workers are especially needed in our wealthy areas where the staff cannot afford to live.
I'm just wondering from where will these additional 12,000 RNs and 77,000 aides come.
There already is a significant shortage of trained nurses and aides. Studies show the shortage will continue and be exacerbated by the number of nurses who leave the profession.
"The data reveals that 100,000 nurses left the workforce during the pandemic and by 2027, almost 900,000, or almost one-fifth of 4.5 million total registered nurses, intend to leave the workforce, threatening the national health care system at large if solutions are not enacted."
Well... What's the solution? Higher cost, better staffing or substandard care, malnutrition, falls, bed sores, sepsis, deaths.
The costs to stay at nursing homes are already sky high, so maybe someone should investigate what costs so much if the money isn't spent to provide better care.
CEOs greed?
Nursing homes and assisted living facilities are phenomenally profitable businesses. They are in business to make money not to provide quality care.
Well... What's the solution? Higher cost, better staffing or substandard care, malnutrition, falls, bed sores, sepsis, deaths.
We all know that the healthcare system is totally broken.
Is "we all know" the same as "everyone assumes"?
The Everybody Knows Fallacy "There is nothing that grinds my gears quite like the phrase "everybody knows." It is deployed by all kinds of folks in all kinds of situations and is very rarely, maybe never, true.
The thing about everybody knowing something is that “everybody” is a finite group of people. When we say "everybody," what we mean is, "everybody I talk to." "
Well... What's the solution? Higher cost, better staffing or substandard care, malnutrition, falls, bed sores, sepsis, deaths.
The costs to stay at nursing homes are already sky high, so maybe someone should investigate what costs so much if the money isn't spent to provide better care.
CEOs greed?
Nursing homes and assisted living facilities are phenomenally profitable businesses. They are in business to make money not to provide quality care.
We all know that our healthcare system is totally broken. There isn't easy fix to solve it.
While there are some bad players in the for profit nursing home business, the root of the problem is that medicaid reimbursement is so low, the not-for-profits could not stay in business.
"Susan McCrary, chief executive of St. Ignatius Community Services in Philadelphia, said her organization sold its nursing home because it was losing money. She said low state Medicaid rates forced their hand, even after the state bolstered its Medicaid payments by 17.5% in January 2023."
The overall perception of for-profit corporations is unfair, said Zach Shamberg, CEO of the Pennsylvania Health Care Association, because all nursing homes are struggling under inadequate Medicaid rates and high labor costs due to a shortage in workers.
He said he hopes that Pennsylvania’s Medicaid rate increase — plus a new minimum staffing requirement and a mandate that 70% of total costs be dedicated to resident care — will address the financial and quality issues. Nursing homes in Pennsylvania and across the country are also lobbying state lawmakers and the federal government to offer extra payments tied to quality outcomes for residents. https://fortune.com/2024/03/12/nursi...rivate-equity/
There needs to be accountability for outcomes in the form of financial incentives.
The Biden administration finalized on Monday the first-ever minimum staffing rule at nursing homes.
All nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift.
Plus, nursing homes must have a registered nurse onsite at all times. The mandate will be phased in over three years, with rural communities having up to five years.
If you've visited a relative there who's thirsty and covered with bedsores, you'll understand why.
As someone who has worked in SNFs for almost 30 years, I can say the majority are not going to be able to staff to that level. Most homes are short-staffed chronically even under older guidelines.
And care will decline in other areas from food to cleanliness, as the profit margin is already razor thin to non-existent, due to low Medicaid reimbursement and more people on Medicare Advantage plans (long term Medicaid patients always lost homes money, but they made up for that with rehab beds, now Advantage plans cut people from rehab in 2-3 weeks vs up to 100 days with traditional Medicare, so they have no way to make up for the money lost on long term patients). Add to that the increased need to use agency nurses and aides, which costs a fortune. Many homes, especially in rural areas, will simply close, leaving care deserts in those areas.
What are they supposed to do, start a stopwatch every time they change someone's diaper? What about the residents who are independent and don't need direct care?
Well... What's the solution? Higher cost, better staffing or substandard care, malnutrition, falls, bed sores, sepsis, deaths.
The costs to stay at nursing homes are already sky high, so maybe someone should investigate what costs so much if the money isn't spent to provide better care.
CEOs greed? Nursing homes and assisted living facilities are phenomenally profitable businesses. They are in business to make money not to provide quality care.
89% of nursing homes have profit margins of 3% or less (73% for assisted living facilities)
55% of nursing home are operating at a loss (50% for assisted living facilities)
Well... What's the solution? Higher cost, better staffing or substandard care, malnutrition, falls, bed sores, sepsis, deaths.
Probably the latter, sorry to say. Modern society, culture, and economics are all making the problem and the solution plain as day, but nobody wants to say it or even tackle it openly.
Clearly humans aren't mean to endure lifespans as long as possible, simply for the sake of being kept alive with drugs or other treatments. These nursing homes are horrible places that few people want to visit, and I can see why few would want to work there. It's sad.
When our pets are unable to eat, walk, or are incontinent, we allow for a gentle and dignified end of life, so that those left behind can go on without burden. We should be allowing the same option for our human elders.
As someone who has worked in SNFs for almost 30 years, I can say the majority are not going to be able to staff to that level. Most homes are short-staffed chronically even under older guidelines.
And care will decline in other areas from food to cleanliness, as the profit margin is already razor thin to non-existent, due to low Medicaid reimbursement and more people on Medicare Advantage plans (long term Medicaid patients always lost homes money, but they made up for that with rehab beds, now Advantage plans cut people from rehab in 2-3 weeks vs up to 100 days with traditional Medicare, so they have no way to make up for the money lost on long term patients). Add to that the increased need to use agency nurses and aides, which costs a fortune. Many homes, especially in rural areas, will simply close, leaving care deserts in those areas.
What are they supposed to do, start a stopwatch every time they change someone's diaper? What about the residents who are independent and don't need direct care?
EXCELLENT post!
The bill sounds wonderful -- but where will the additional staff come from?
I don't have any figures, but I have read that the reason nursing homes are understaffed is because there are not enough people available who can and are willing to do the work.
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