Rural nursing homes across the country, already understaffed, face significant new federal staffing requirements. With on-the-ground reporting from INN’s Rural News Network and data analysis assistance from USA TODAY and Big Local News at Stanford University, eight newsrooms explore what the rule change would look like for residents in communities across America. Support from The National Institute for Health Care Management (NIHCM) Foundation made the project possible.
Joanie Stein felt remorse for putting her 81-year-old mother, former nurse Carol Kingsley, in the Regency Olympia Rehab and Nursing Center in Lacey.
“I feel guilty for putting her there,” Stein told KING5 News a few days after her mother died of complications from COVID-19 in August 2021.
Stein added that the staff at the nursing home had told her that when she requested her mother be taken to the hospital, they did not act on the request because they said Kingsley’s DNR (Do Not Resuscitate) order stated she was to be provided comfort care only.
Stein refuted this, telling the Seattle NBC affiliate the facility’s residents were “not being protected from getting COVID since the staff members aren’t using proper PPE (personal protective equipment) when dealing with infected patients, and because my mom wasn’t given proper care, in my opinion.”
Kingsley was one of the 559 people in Thurston County and nearly 16,000 in Washington State who died during the pandemic. Of the more than 1.45 million Americans who died of COVID-related illness, more than 200,000 were residents and staff in long-term care facilities. These deaths aroused the public’s awareness about staffing levels and other challenges confronted by nursing homes.
In response to concerns raised during the pandemic about nursing homes’ staffing levels, on September 1, 2023, the Biden administration issued a proposal to establish comprehensive staffing requirements for skilled nursing facilities (aka nursing homes) across the country.
The Department of Health and Human Services (HHS), through its Centers for Medicare & Medicaid Services (CMS) division, issued a proposed minimum nursing staff standard for facilities participating in Medicare and Medicaid to ensure safe, high-quality care and dignity to the over 1.2 million residents currently living in nursing homes.
Specifically, nursing homes will be required to provide residents with a minimum of 0.55 hours of care from a registered nurse (RN) per resident per day, and 2.45 hours of care from a certified nursing assistant (CNA) per resident per day. These new standards exceed existing standards in nearly all states.
CMS estimates that about 75 percent of nursing homes nationwide would need to increase staffing in their facilities. As the long-term care sector continues to recover from the COVID-19 pandemic, the proposed standards take into consideration local realities in rural and underserved communities through staggered implementation and exemption processes.
The plan is for the proposed rule to be finalized in 2024. As it now stands, however, staffing requirements would be phased in over three years, with greater flexibility to allow rural nursing homes to meet the new standards.
CMS Administrator Chiquita Brooks-LaSure called the proposed new staffing requirements “an important first step ... that will hold nursing homes accountable and make sure residents get the safe, high-quality [care] and dignity that they deserve.”
Closer to home in Thurston County, there are seven skilled nursing facilities – all of which are located in the urban areas of Olympia and Lacey. Those are:
The JOLT made repeated calls to all seven facilities to inquire about the percentage of clients served from rural areas as opposed to urban areas and how staffing levels would be affected by the proposed federal requirements. One executive director we spoke with invited us to call back in 15 minutes – but then did not answer the phone when we did. None of the other facilities responded.
Staffing levels for RNs and CNAs will need to be significantly boosted in coming years, according to data analyzed by The JOLT, USA TODAY and Big Local News at Stanford University. The Nursing Home Staff Analysis for the second quarter of 2023, enabled a statistical analysis of how well these seven nursing homes are currently meeting the Biden administration’s proposed guidelines. That study is based on payroll data from CMS. Supporting this analysis are the findings of Nursing Home Inspect, published by ProPublica.
Meeting Minimums for Registered Nurses (RNs):
On average, the seven local nursing homes met CMS’s proposed minimum staffing levels for RNs on 54 of the 91 days during the second quarter of this year. On the other 37 days, they would not meet the new minimum staffing requirements if they were in effect.
Example: Roo Lan Health & Rehab reported the fewest hours of RN care per resident. This means that the facility would be 10 hours short of care per day per patient under the new standards. It would need to hire 1.8 more full-time RNs.
Meeting Minimums for Certified Nursing Assistants (CNAs):
On average, the seven nursing homes met the CMS’s proposed minimum staffing levels for CNAs on 36 of the 91 days of the second quarter of 2023. On the other 55 days, these seven nursing homes would not have met the new minimum standards.
Example: While Lacey Post Acute & Rehabilitation had the highest average of RNs of the three skilled nursing facilities in Lacey, it had the lowest numbers for CNAs. On an average day, the facility reported falling 48 hours short of the Biden standard, which translates into needing another 8.5 full-time CNAs.
Summary of Both RN and Aides Minimums
Based on the CMS data provided for the second quarter of this year, these seven local nursing homes would have met the proposed staffing standards for RNs on 53 days and for CNAs on 36 days.
“The administration’s proposal is an important first step,” said Nancy LeaMond, AARP’s chief advocacy officer. “The lack of standards and poor-quality care in too many of America’s nursing homes is deadly.”
The JOLT is a member of the Rural News Network.
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KatAshe
Finding a safe nursing home for a loved one can be difficult, but there are a few things that are a tip off to the bad ones.
When going to look at a prospective nursing home, first use your nose. A safe nursing home doesn’t allow patients to remain in their own waste, but cleans patients quickly and puts them in clean clothing and bedding. Second, use your eyes and ears. Do patients seem in distress, crying or calling out for attention? Are communal areas in use or do patients seem isolated in their rooms? Do visible meal trays appear to be uneaten well after normal feeding times, or left for hours to clear away? In a non memory care facility, do patients appear mostly alert and capable of social interaction (if not they be being unnecessarily medicated), lastly does the facility encourage visiting with reasonable hours, or do they restrict to just a very few hours daily? Does the nursing home allow you to speak with current residents?
The above won’t guarantee a great nursing home, but will avoid the worst ones. Great nursing homes encourage friends, family and outsiders to visit and engage with patients, whether just reading, engaging in activities, helping with feeding, etc.
Saturday, December 16, 2023 Report this
psterry
Nurses don't (and shouldn't) come cheap. The unintended consequence of this is that the cost of service will rise, as will the price of a room.
Saturday, December 16, 2023 Report this
olyhiker
I had a friend at Brookdale East. His room was a mess. I ended up vacuuming, dumping his wastebasket, bringing his clothes home to wash, etc. He had a 'button' hanging around his neck but he waited hours sometimes for help.
Saturday, December 16, 2023 Report this
Trcutler1
Had a loved one put in Roo Lan. Was the most disgusting place I’ve ever seen. Took us a year to get her out of there. They didn’t care about her. All they cared about was the money they were collecting from her. We finally got her out and into a private home. She lived for another two years. In there she was on deaths door everyday. To my family… if I ever get to that place we’re I have to be put into one of these places, please just take be out back and shoot me.
Sunday, December 17, 2023 Report this