Most long-term care facilities in Missouri will need to hire more nursing staff to comply with new federal requirements that the Centers for Medicare and Medicaid Services announced this week.
Under the new rule, homes that receive federal funding must have nursing staff — which could include registered nurses, licensed professional nurses and nurses’ assistants — to cover about 3½ hours of care per resident per day. The new rules also require a registered nurse to be on staff 24 hours a day.
A nursing home with 100 beds would need more than a dozen nursing staff members available per shift, explained Priya Chidambaram, a Medicaid policy expert at KFF, a national health policy research organization.
“What that translates to is a facility with a hundred residents having two to three RNs and 10-11 nurse aides and a couple more nurse staff per shift,” Chidambaram said.
Based on federal data, only 11% of homes in the state currently comply with the new rules, she said.
Advocates for workers and patient safety in Missouri largely supported the regulations, but owners and representatives from industry groups said the new rule created unrealistic standards for an industry that already struggles with hiring and retaining employees.
“We have struggled as it is getting RNs,” said Kerri Lauterbach, CEO of Beth Haven, a 105-bed retirement home in Hannibal. “Trying to get RNs in the door for a 24-hour requirement seems near impossible.”
Long-term care centers have up to five years to meet the new standards, with rural facilities given more time to comply. The rollout gradually ramps up requirements, with the minimum nurse staffing standards kicking in before requirements about the proportion of each kind of nurse needed.
Facilities that receive Medicaid reimbursement must comply. If not, they face fines or risk losing their funding. A facility could receive an exemption to the rule if its owners prove they have made good faith efforts to hire enough workers, according to CMS.
“I would not be opposed to having a 24-hour-a-day RN; that would be great. But there are too many challenges right now to making that happen," Lauterbach said.
She added the requirement that an RN needs to be on site at all times adds to the perception such facilities are unsafe.
Nurses also can make more money doing less taxing tasks by working somewhere else, said Bill Bates, CEO of LeadingAge Missouri, an industry association that represents mostly nonprofit facilities.
“Hospitals who also need nurses pay more for lighter duty than is often found in a long-term-care nursing home facility where the work is hard,” he said.
Missouri ranks second to last in the nation in the hours of care nursing home residents receive from nurses per day, according to an analysis from the Long Term Care Community Coalition.
Patient advocates say the new rules will increase the health and safety of the state’s more than 34,000 residents who live in nursing facilities.
“It's making sure that residents are getting hands-on care, because this is everything from insulin draws [to medication giving and checking to see if somebody is having an episode with one of their health conditions,” said Marjorie Moore, executive director of VOYCE, a group that advocates for nursing homes residents and their families. “But this is also things like taking residents to the bathroom and helping them eat and getting them out of bed.”
But the nursing home industry has a lot of work to do to make sure there are enough nurses and assistants trained to fill required jobs, Moore said.
The federal government has set aside $75 million to launch a national nursing home staffing campaign to increase the number of nurses in nursing homes.
Staffing requirements will keep more people on the job, said Lenny Jones, state director of the Service Employees International Union, which represents nursing home workers.
“Low staffing leads to incredible staffing turnover,” he said. “Somebody comes on board and sees what the duties of their job are and [that] they're not able to provide the care they want to provide to residents because they're so understaffed. There's so many demands on them and they quit.”
The Missouri Department of Health and Senior Services inspects more than 1,000 nursing homes annually. About 500 of them receive Medicare and Medicaid funding.
