What to Know About the CMS Staffing Mandate

At a time when many senior living providers are already dealing with chronic staffing shortages, a recent final rule on minimum staffing requirements from the Centers for Medicare and Medicaid Services (CMS) has many industry leaders concerned about the impact. The rule’s anticipated fallout has spawned several lawsuits and lobbying campaigns against its implementation. 

For senior living community leaders, it’s important to understand this hotly contested debate and how the finalized rule could impact your business. Here’s what you need to know and how you can prepare.

The CMS Wants to Ensure Safer, Higher-Quality Resident Care

The goal of the staffing mandates, the CMS says, is to help provide senior residents with better care and increased safety. More specifically, the new rule is meant to shore up what has become a dire staffing crisis across the industry, one that has led some residents to sustain preventable injuries and even sacrifice basic levels of hygiene. 

These breakdowns in care don’t just worsen residents’ quality of life – they also erode families’ trust in the promise of senior living. 

The finalized CMS rule aims to solve this problem by standardizing both the amount of resident care and the number of staff available to provide it. Set to go into effect in the coming two years, the rule requires Medicare- and Medicaid-certified communities to…

• Meet a baseline of care hours. Residents must receive a minimum total of 3.48 hours of nursing care per day, to include at least 0.55 hours of care from a registered nurse (RN) per resident per day, and 2.45 hours of care from a nurse aide per resident per day. 
• Always have a registered nurse on site. Facilities must have an RN available 24 hours per day, seven days per week.
• Strengthen their annual facility assessment. Communities should proactively plan to improve how they identify must-have resources for resident care.
• Develop a long-term staffing plan. The focus: maximizing recruitment and retention. 

The CMS says that it received more than 46,000 public comments on its proposed rule, with many highlighting the need for elevated staffing levels to ensure necessary care and increased safety for residents. Alongside the new mandates, the agency has also committed to developing a $75-million national nursing home staffing campaign to increase the number of nurses in nursing homes. 

But the Rule Could Push Communities to the Brink

Because staffing already represents a significant headwind for many providers, the new CMS rule projects to pose a considerable burden across the industry. In fact, a recent analysis of the rule’s potential impact from AHCA / NCAL Research unearthed a number of sobering findings: 

• Most communities are a long way from compliance. Only six percent currently meet all four requirements of the CMS rule. 
• Nurses are hard to come by. Eighty percent of senior living communities will have to hire more RNs to meet the 24 / 7 mandate, including 92 percent of rural facilities.
• Hiring will come with a hefty price tag. Senior living communities will have to hire an additional 102,000 nurses and nurse aides to comply with the mandate, at an estimated cost of $6.5 billion annually.
• The mandate could ultimately hurt residents. Nearly one quarter of  residents – more than 290,000 in total – may be at risk for displacement, as facilities are forced to reduce their census in order to comply with the mandate, or ultimately close altogether.

Thankfully, Congress has shown some willingness to modify or rein in the new provision, largely due to the potential strain on the industry and the real possibility of shutdowns due to noncompliance. Even so, both AHCA and LeadingAge have sued to fight the new rule – a signal of deep concern from industry leaders about their ability to meet these minimum standards, much less exceed them.

But CMS and its advocates don’t plan to go down without a fight. For example, while AARP has acknowledged the concerns and objections of providers regarding the rule, the seniors group is still strongly in favor of the new staffing mandates and plans to launch an advocacy campaign in support.

Tech can Help You Prepare for the New Staffing Mandate

There’s still a lot of uncertainty about the future of this rule. But it’s smart to plan as if it will go forward in something close to its current form. That means doubling or tripling down on staff recruiting and retention efforts – something you’ve likely already committed to doing.  

It’s also important to remember that senior living technology can automate many routine tasks that could save staff enough time to comfortably meet the new hours minimum. If you haven’t already, consider investing in tech like…

• Communication tools that automate wellness check-ins.
• Smart home technology (such as Amazon Alexa devices or connected wearables) that can make it easier for residents to manage their own care needs and alert staff in case of emergency.
• Staff scheduling tools that help you fill open shifts to consistent coverage.

While tech won’t solve every challenge, it will likely smooth out your path to compliance.

Be Proactive to Overcome Staffing Challenges 

Staffing issues and discussions aren’t going away anytime soon. Whether the CMS rule progresses in its current form or somehow gets blocked or altered along the way, senior living communities should always be planning for how to best care for their residents. Even without a mandate, after all, the benefits of forward-thinking preparation are too good to ignore – both for residents and staff. 
Need a digital partner in that effort? We can help. Book a demo today to find out how.