Minimum Nursing Home Staffing Standards: A Good Start, But Not Quite There

Jasmine Travers

The pandemic shone a troubling spotlight on the unnecessary suffering resulting from substandard conditions in nursing homes. On Sep 6, 2023, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule for their widely anticipated minimum staffing requirements for long-term care facilities. A 2022 Nursing Home Staffing study that was convened to inform the development of these requirements followed an urgent plea from the Biden Administration and National Academies of Sciences, Engineering, and Medicine’s Committee on the Quality of Care in Nursing Homes for every nursing home to provide a sufficient number of staff so that the quality of care and safety in nursing homes might be addressed.

Tara Cortes

The proposed requirements.

An abundance of qualitative interviews, surveys, listening sessions, and comments from the public yielded the following staffing requirements:

  1. Minimum staffing hours per resident day (HPRD) for registered nurses (RNs)—0.55 HPRD—and nurse aides (NAs)—2.45 HPRD. Outside of these hours, sufficient additional nursing […]
2023-10-19T10:05:15-04:00October 19th, 2023|Nursing, Nursing homes|1 Comment
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Medicare Turns 50: Familiar Opposition in 1965, Essential and Continuing to Evolve Now

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration. President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

On this date in 1965, exactly 50 years ago, Medicare (part of the Social Security Amendments of 1965) was signed into law by President Johnson. The debate over government-sponsored health insurance is not new, and opposition to the creation of Medicare was similar to the opposition to the Affordable Care Act and driven by many of the same organizations and arguments.

According to a timeline at SocialSecurity.gov, Congressional hearings on the topic occurred as early as 1916, with the American Medical Association (AMA) first voicing support for a proposed state health insurance program and then, in 1920, reversing its position. A government health insurance program was a key initiative of President Harry Truman, but, as with the Clinton health initiative several decades later, it didn’t go anywhere because of strong opposition from the AMA and others.

AJN covered the topic in an article in the May 1958 issue after a health insurance bill was introduced in 1957. Yet again, one of the staunchest opponents was the AMA. In the September 1958 […]

2016-11-21T13:02:12-05:00July 30th, 2015|career, health care policy, Nursing, nursing perspective, Patients, Public health|0 Comments
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Nursing Homes Need Nurses

By Amy M. Collins, managing editor

nursing home Photo by Ulrich Joho, via Flickr.

Recently, the Association of Health Care Journalists (AHCJ) released updated nursing home inspection data, which is “derived from a large file that is split up for easier use by members.” (Members get a data set containing three years of the most severe deficiencies found during inspections, as well as current ratings assigned by the Centers for Medicare and Medicaid Services [CMS]. To register for membership and gain access to more detailed information, click here.)

A news release put out by AHCJ based on their analysis of these ratings isn’t pretty. The latest number of deficiencies recorded by the CMS (which range from “isolated incident of actual harm” to “widespread immediate jeopardy to resident health or safety”) has reached 16,806.

Medicare ratings themselves have also been called into question in a recent article suggesting that nursing homes with the highest ratings may be gaming the system. Despite these ratings being the gold standard in the industry, the data they are based upon on is largely self-reported by the nursing homes and not verified by the government. Often, details such as fines and other enforcement actions by the state, as well as complaints filed by consumers with state agencies, are left out.

Could part of the problem be […]

2016-11-21T13:03:59-05:00September 4th, 2014|nursing perspective, nursing research|14 Comments
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Working Out the Bugs: Old and Alone in the City

Amanda Anderson, BSN, RN, CCRN, works in critical care in New York City and is enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She tweets at @12hourRN.

Old Woman Dozing/Nicolas Maes Old Woman Dozing/Nicolas Maes

At work the other day, after almost seven years as a nurse, I had an experience that completely floored me. While connecting a bag of cefepime to my tiny, elderly, blind patient’s IV, I spotted a cockroach making its way across her pillow. And then another on her lap. And then they were on the wall behind the bed, coming out of the closet where her belongings were stored. Another nurse had just handed her the pocketbook she’d requested, and the host of insects that apparently called it home were now scurrying quickly around the room, and around me.

I consider myself a fairly brave woman. I can kill a bug if I need to, I see rats quite frequently, and come on, I’m a nurse—there have been some pretty gory things to pass these eyeballs and touch these fingers. But this was different; it was not the hospital grossness that I am a seasoned veteran of. This was a glimpse into my patient’s dirty home. I ran like a little child.

When the situation had calmed […]

2016-11-21T13:05:09-05:00March 19th, 2014|nursing perspective|3 Comments
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Bad News, Good News: Berwick, a Casualty of Politics, Succeeded at CMS Helm by a Nurse

By Shawn Kennedy, MA, RN, editor-in-chief

When Donald Berwick steps down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) on December 2, he’ll turn the reins over to Marilyn Tavenner, MHA, BSN, RN. Tavenner is not a new face at CMS—she served as acting administrator prior to Berwick’s July 2010 appointment by President Obama and has been principal deputy administrator at CMS since February 2010.

As noted by an article in The Washington Post, Berwick is stepping down in the face of organized opposition to his nomination by Republicans in Congress, who have vowed to block the confirmation he’d need to continue after his recess appointment expires on December 31.

On November 23, President Obama announced his intent to nominate Tavenner for the top post. In her e-mail to CMS staff (carried on the Kaiser Health News site), Kathy Sebelius, secretary of  Health and Human Resources, says of Tavenner, “Her career as a nurse, hospital administrator, and Virginia Secretary of Health and Human Resources give her unique insights that position her well to serve as Administrator.”

I certainly hope so. Berwick’s reputation and track record for pinpointing problems in our health system—and more importantly, working to do something about them through the Institute for Healthcare Improvement—was stellar, and he carried this zeal […]

2016-11-21T13:11:20-05:00November 30th, 2011|Nursing|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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