Staffing challenges have been prevalent in nursing care since the pandemic, and a federal minimum staffing rule coming down the pike could have a negative impact on some facilities. A recently published brief from Altarum highlights significant variation among states in the percentage of nursing homes that meet the new federal staffing standards.
Earlier this year, a “State of the Sector” report by the American Health Care Association found that of nearly 450 nursing home providers surveyed, two-thirds are concerned that escalating workforce challenges could force them to close their facilities. More than 70% of nursing homes reported staffing levels lower than before the COVID-19 pandemic, with fully 99% saying they are hiring for open positions.
Altarum in its recent report analyzed skilled nursing home staffing levels based on the Payroll-Based Journal (PBJ) Public Use Files for nursing staff, submitted quarterly by nursing homes in the U.S. and published by CMS.
The report’s author, Altarum Fellow and Senior Researcher George Miller, noted that there is a wide variation among SNFs nationwide in their ability to meet the required daily minimum of 2.45 hours of nurse aide time per resident per day (HPRD), and 0.55 daily hours of time by registered nurses per resident. The final rule added a requirement for an additional 0.48 HPRD, which can be provided by any combination of nursing staff (RNs, licensed professional nurses, licensed vocational nurses, or NAs).
The data show that in the fourth quarter of 2021, 53% of the nation’s SNFs would have met the new RN standard, 28% would have met the new NA standard, and 20% would have met both standards. Factoring in the recently added 0.48 HPRD requirement appears not to have altered the 20% that could have met both standards. Only five fewer SNFs would have met the standard with the additional 0.48 HPRD requirement than without it.
An analysis by KFF in August 2023 yielded similar findings, with 52% of SNFs meeting the RN standard, 27% meeting the NA standard, and 19% meeting both.
Altarum’s report also explored the relationship between a nursing home’s ability to meet the standards and factors such as rural versus non-rural location, for-profit versus nonprofit ownership, the percentage of residents in the home who are persons of color and the percent of residents in the home whose primary funding is Medicaid, as opposed to higher funding levels from Medicare or private payer.
“While the location of a nursing home is not a significant predictor of the probability of meeting the standards, all of the other three characteristics lower the probability of meeting the standards and are highly significant,” Miller told the McKnight’s Business Daily on Friday.
The brief also looks at variation among states and how those four characteristics affect the percent of nursing homes meeting the standards in each state.
“There is wide variation among states in the percent of nursing homes that meet the new standards, ranging from 100% in Alaska to 2.4% in Louisiana,” Miller said. “This variation is driven in part by differences among states in the impact of for-profit status, racial mix and percent of residents funded by Medicaid on whether a nursing home in a state meets the standards.”
