A new law dictating minimum registered nurse staffing ratios in care homes in the US has been unveiled by the country’s federal government, in response to excess deaths during the Covid-19 pandemic.
On Monday, 22 April, US vice president Kamala Harris announced the Nursing Home Minimum Staffing Rule, the final version of a long-promised law that will require nursing homes to comply with a minimum ratio of registered nurses and other staff to patients.
“We are working to make sure no nursing home can sacrifice the safety of their residents just to add some dollars to their bottom line”
Joe Biden
Nursing homes will be required to have 3.48 hours of staffing per resident per day, of which 0.55 must comprise registered nurses and 2.45 must be nurse aides – equivalent to a healthcare assistant.
A Whitehouse briefing explained that this would mean a setting with 100 residents would need a minimum of two to three registered nurses, 10-11 nurse aides and two additional nursing staff, who could be registered or non-registered.
Many nursing homes, the briefing continued, would be mandated a higher minimum staffing level depending on the needs of residents.
Further more, the new law would require a setting to always have a registered nurse on site, including at night and over the weekend.
The law would apply to all nursing homes that receive federal – central government – funding via the country’s Medicare and Medicaid programmes.
The Whitehouse said there would be “limited, temporary exemptions” for these rules in order to allow nursing homes time to hire the required staff.
Now in the public comment phase, the law could take years to be put into force. If it is, the government said it would be implemented in phases, with rural areas given longer to comply.
Minimum social care staffing in the US was first promised by president Joe Biden in 2022, after reports suggested that more than 200,000 care home residents died of Covid-19 in just two years, and that staffing levels had plummeted in the wake of the pandemic.
The new law is a landmark step in the regulation of health and social care in the country, and a minimum staffing level was welcomed by many patient and staff advocacy groups.
Mr Biden, writing in the newspaper USA Today, said the new law would end “abuse” to patients due to poor staffing.
“We are working to make sure no nursing home can sacrifice the safety of their residents just to add some dollars to their bottom line,” the president said.
“Unfortunately, too many Americans across the country know firsthand how hard it can be to find a nursing home that provides that peace of mind…,” he added.
“Despite nursing homes receiving nearly $100bn annually from American taxpayers, too many facilities are understaffed, which can result in severe illness and even death for residents.”
However, some groups criticised Mr Biden’s government for not going far enough, while some private sector representatives warned it was financially unviable for some settings.
Richard Mollot, head of the Long Term Care Community Coalition, told AP News that he felt the minimums were “completely inadequate”, and a missed “once-in-a-generation opportunity”.
Mr Mollot said: “It is a tremendous dereliction of duty. We are continuing to allow nursing homes to warehouse people and to rip the public off.”
Meanwhile, Mark Parkinson, chief executive of the American Health Care Association and National Centre for Assisted Living, which represents around 14,000 nursing homes in the US, said he was “extremely disappointed” and “troubled” by the new rules that he said were far too stringent.
He said: “While it may be well intentioned, the federal staffing mandate is an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors’ access to care.”
He described the minimums as “out of touch and out of reach”, and added: “For the sake of our nation’s seniors and their caregivers, we must find a better way.”
Similarly, the American Hospitals Association’s executive vice president, Stacey Hughes, expressed frustration at what she described as a “one size fits all” approach taken by the government.
“The minimum staffing rule for nursing homes creates more problems than it solves and could jeopardise access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements,” she said.
“This final rule could lead nursing homes to reduce capacity or close outright, including those that are otherwise high performers on quality and safety metrics,” she said.
“The loss of these nursing home beds could adversely impact patients who have completed their hospital treatment and need continuing care in nursing facilities.”
Ms Hughes added: “This final rule could exacerbate the already serious shortages of nurses and skilled healthcare workers across the care continuum.
“Strengthening the health care workforce requires investment and innovation, not inflexible mandates.”
AP News reported that the government was “open” to revisiting the specific minimums once the law was put into place.