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Nursing Home Staffing

Nursing Home Staffing has been an issue for some time. Insufficient staffing results in a poor quality of life for residents, resident safety and staff retention issues. DignityMA has compiled current information on the topic. There are a number of reasons for inadequate staffing. DignityMA is focusing on what the standard should be, problems achieving a standard, as well as what are the barriers to accessing statistics. Nursing Home ownership changing to Private Equity has not helped.

In September of 2023, CMS released a Notice of Proposed Rule Making (NPRM) that would implement a minimum staffing standard in nursing homes. DignityMA submitted Comments on CMS-3442-P on November 6, 2023.

DignityMA members attended a webinar by the Consumer Voice on unpacking CMS’s Notice of Proposed Rule Making (NPRM) The webinar walked through the rule and its provisions. Additionally, the rule relies heavily on a staffing study conducted last year. Consumer Voice explains this study and how CMS used it to come to the proposed standard in the rule. This webinar is the first step in a series of events that will provide you with the information necessary to comment and make this rule stronger. View slides from the Consumer Voice Webinar.

A September Spotlight: HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes has more information.

Publicly Accessible Staffing Data

Arlene has provided the information that follows (1/29/2024):

A major barrier to understanding this issue is the lack of public, accessible staffing data for each facility unit. This data should be available to residents, visitors and DPH. Currently there are federal regulations that require this public data for total facilities, but advocates have been fighting for consistent implementation. We need the data by unit, not just by total facility.

Federal Regulation: § 483.35 Nursing services: The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility’s resident population in accordance with the facility assessment required at § 483.70(e).

“…(g) Nurse staffing information

  • (1) Data requirements. The facility must post the following information on a daily basis: (i) Facility name., (ii) The current date., (iii) The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift:, (A) Registered nurses., (B) Licensed practical nurses or licensed vocational nurses (as defined under State law)., (C) Certified nurse aides., (iv) Resident census.
  • (2) Posting requirements. (i) The facility must post the nurse staffing data specified in paragraph (e)(1) of this section on a daily basis at the beginning of each shift., (ii) Data must be posted as follows:, (A) Clear and readable format., (B) In a prominent place readily accessible to residents and visitors.
  • (3) Public access to posted nurse staffing data. The facility must, upon oral or written request, make nurse staffing data available to the public for review at a cost not to exceed the community standard.
  • (4) Facility data retention requirements. The facility must maintain the posted daily nurse staffing data for a minimum of 18 months, or as required by State law, whichever is greater.

As additional background, CMS guidance to DPH surveyors provides the following background: INTENT §483.35(g)

To make nurse staffing information is readily available in a readable format to residents and visitors at any given time.

GUIDANCE to Surveyors §483.35(g) The facility’s staffing data “document” may be a form or spreadsheet, as long as all the required information is displayed clearly and in a visible place. The information should be displayed in a prominent place that is readily accessible to residents and visitors and presented in a clear and readable format. This information posted must be up-to-date and current. The facility is required to list the total number of staff and the actual hours worked by the staff to meet this regulatory requirement. The information should reflect staff absences on that shift due to call-outs and illness. Staffing must include all nursing staff who are paid by the facility (including contract staff). The nursing home is not required to include in the posting the data for staff who are paid for through other sources; examples include hospice staff covered by the hospice benefit, or individuals hired by families to provide companionship or assistance to a specific resident.

Additional Resources