For residents of nursing homes and other long-term care facilities, lack of sufficient staff has become an increasingly urgent concern in recent years. The shortage in this critical area of health care, linked in part to employee burnout and turnover, became even more evident when hundreds of thousands of people living in nursing homes died amid the COVID-19 pandemic.

If your aging parents or other loved ones are among the more than 1 million Americans residing in a nursing home, you may be worrying about the level and quality of care they are receiving each day.

How do I choose a Long-Term Care Facility for older adults?

Research suggests that higher nurse staffing levels in long-term care facilities lead to better health outcomes for patients. Yet for decades, the federal government has not altered any of the standards regarding nursing home staffing.

“When facilities are understaffed, residents suffer,” Xavier Becerra, Secretary of the Department of Health and Human Services, said in a U.S. Department of Health and Human Services news release. “They might be unable to use the bathroom, shower, maintain hygiene, change clothes, get out of bed, or have someone respond to their call for assistance.”

Fortunately, when selecting a nursing home for an aging loved one, there are some useful resources at your disposal. For example, you can access information about staffing levels at local facilities through Medicare’s free online Care Compare tool. U.S. News & World Report is another source that offers ratings on nursing homes. In addition, the American Council on Aging provides a searchable database of nursing homes near you that accept Medicaid and Medicare.

What is being done to regulate minimum nursing home staffing?

The federal government is now seeking to take steps toward regulating nursing homes on the staffing front. In September 2023, the Biden administration introduced the idea of requiring any long-term facility that accepts Medicare or Medicaid to meet a minimum staffing level. The goal of its proposal is to improve the safety and quality of care of residents living in these types of facilities across the country.

Among the minimum staffing requirements outlined in this initiative are the following points:

• Long-term care facilities must ensure there is a registered nurse (RN) on site 24-7.
• These facilities would need to have a baseline number of RNs and nurse aides (about one RN per every 44 residents and one nurse aide for every 10 residents, with each patient receiving at least three hours of direct care per day).
• Long-term care facilities must include input from nurses, managers, and other staff members in their annual assessments.
• Nursing homes in rural areas would have more time to implement some of the proposed changes.

According to the proposal, the government would also take steps to enforce these standards. This would include auditing facilities’ staffing data, analyzing nursing homes’ use of funds, and expanding inspections of long-term care facilities, in addition to other measures.

“When nursing homes stretch workers too thin, residents may be forced to go without basic necessities like hot meals and regular baths, or even forced to lie in wet and soiled diapers for hours,” the White House stated in a fact sheet about the proposal.

As part of the effort to help long-term care facilities meet these standards, the Centers for Medicare and Medicaid says it will invest in scholarships and tuition reimbursement for aspiring nurses. The federal government also plans to provide grant funding meant to train more professionals in the field.

How can I share the experiences of my loved one in long-term care?

The proposal has earned the support of organizations such as AARP and Justice in Aging. Yet it also has drawn the ire of numerous lobbyists, health care providers, and nursing home industry groups.

These opponents have raised such concerns as the costs associated with hiring more nursing home staff. Some point to the existing shortage in nursing professors across higher education institutions as a reason for the deficiency in staffing numbers. Others warn that once the new staffing minimums are implemented, many facilities may have to close if they are unable to meet those minimums. Meanwhile, some patient advocates have expressed disappointment that the mandate is not strict enough.

National nonprofit Justice in Aging, which supports the mandate, issued an email encouraging the public to submit comments on the proposal. “Inadequate staffing is at the root of poor care,” it said. “Importantly, the proposed regulations are just that: proposed.”

If you wish to weigh in the experiences of your loved one in long-term care, you can submit your input online or via the mail. The proposal is open to comments from the public through November 6, 2023.

If you would like to speak with an experienced elder law attorney regarding your situation or have questions about something you have read, please do not hesitate to contact our office at 1 (800) 680-1717. We look forward to the opportunity to work with you.