New federal rules on nursing home staffing worry Georgia providers

Aiming to protect patients, the White House pushes to require nurses in nursing homes. Georgia care homes say the rule is “disastrous.”
(PHOTO via Dreamstime/TNS)

Credit: TNS

Credit: TNS

(PHOTO via Dreamstime/TNS)

A new federal rule announced Monday for nursing homes will set minimum staffing levels, a goal sought by patient advocates after the COVID-19 pandemic uncovered disastrous nursing home staffing shortages in Georgia and nationwide.

Georgia nursing home executives told The Atlanta Journal-Constitution that the rule will be a financial disaster for them because it doesn’t come with assured funding to hire more nurses, and will eventually harm patients if the rule forces some nursing homes to close or cut quality-of-life programs.

The staffing rule will be phased in over the coming two or three years. It will require a certain number of nurse staffing hours per patient present, with rural facilities having more time to ramp up. In addition, it will require at least one registered nurse be on site 24 hours a day, 7 days a week. The health research organization KFF estimated this week that four out of five nursing homes currently don’t meet the final standard.

Vice President Kamala Harris spoke on the rules in Washington Monday, saying it was the first federal rule to set minimum staffing levels at federally funded nursing homes and to require that a certain portion of the taxpayer dollars the homes receive go toward wages for care workers.

Harris said those steps are a long-overdue “milestone” that recognizes the care workers’ value to society. She said the change will mean more staff at these facilities, fewer emergency room visits for residents and peace of mind for caregivers, who will be able to spend more time with their patients.

Deke Cateau, CEO of the nonprofit nursing home operator A.G. Rhodes, which operates homes in metro Atlanta, said it would be daunting to hire enough qualified staff to meet the new requirements.

“I get the the administration and the government really need to fortify staffing in our nation’s nursing homes. I completely get it,” he said. However, he said “anyone who’s worked in a nursing home since COVID would understand that that supply of staffing simply is not there.”

The coronavirus pandemic, which claimed more than 167,000 nursing home residents in the U.S., exposed the poor staffing levels at the facilities and led many workers to leave the industry. Advocates for the elderly and disabled reported residents who were neglected, going without meals and water or kept in soiled diapers for too long.

Staffing agencies stepped in to offer temporary workers, but their cost was much higher. Cateau ran calculations Tuesday morning showing his three homes would require an additional $2 million annually at minimum to reach the new staffing requirements.

Some nursing homes can’t raise money by hiking prices because so many of their patients are on Medicaid and Medicare, which doesn’t negotiate rates home-by-home. Cateau’s first thoughts were that he would have to reduce or cut the programs that keep his residents’ lives interesting: horticulture therapy and other physical activities.

Devon Barill, a spokeswoman for the nursing home industry group the Georgia Health Care Association, said that 1% of nursing homes in Georgia currently completely meet the staffing standards in the new rule. And 51% of homes don’t meet any of the standards.

Officials with the U.S. Centers for Medicare and Medicaid Services (CMS), which made the rule, said the feds had heard the industry’s concerns and worked to develop some exemptions. However, Principal Deputy Administrator Jonathan Blum told the AJC his agency had to take action because homes are also closing because of the poor quality of care.

“The current status quo just can’t be accepted,” Blum said. Other CMS officials said that in the course of developing the rule they had spoken to patients or families of patients who couldn’t eat or go to the bathroom for hours because there were not enough staff to help them, and nurses worked to the bone.

The amount of staffing is closely related to the quality of care and health of patients at a facility, research has found.

During the pandemic, the AJC’s reporting found that Georgia’s nursing homes had some of the lowest staffing levels in the country. Experts said the state’s typical nursing home did not have enough staff to adequately care for a vulnerable population, especially in the midst of a pandemic, when many living in long-term care facilities lost their lives.

Pandemic challenges became worse when patients were grouped physically together to help short-staffed facilities — a method that also allowed sickness to travel between them more easily.

Georgia Ombudsman for Long-Term Care Melanie McNeil, a residents’ advocate, was skeptical of nursing homes’ claims they will close. “Whatever change is proposed, it seems that providers say that facilities will close,” McNeil said in an email. “The number of nursing homes has stayed static for a number of years. I would be very surprised if nursing homes closed because of this change.”

AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy LeaMond commended CMS, saying in a written statement this week that the new rule is “long overdue.”

“Far too many residents and families have experienced tragic consequences because of poorly staffed facilities,” LeaMond wrote. “It is shameful that nursing homes receiving taxpayer dollars through Medicaid and Medicare haven’t been required to provide quality care through specific minimum staffing standards until now.”

President Joe Biden first announced his plan to set nursing home staffing levels in his 2022 State of the Union address. Current law only requires that nursing homes have “sufficient” staffing, leaving it up to states for interpretation.

The vice president said that Medicaid, the federal-state health insurance program for lower-income people, pays $125 billion annually to home health care companies, which were not required to report on how they were spending the money. A second rule being finalized Monday will require that 80% of that money be used to pay workers, instead of administrative or overhead costs, Harris said.

The new rules call for staffing equivalent to 3.48 hours per resident per day, just over half an hour of it coming from registered nurses. The government said that means a facility with 100 residents would need two or three registered nurses and 10 or 11 nurse aides as well as two additional nurse staff per shift to meet the new standards.

The average U.S. nursing home already has overall caregiver staffing of about 3.6 hours per resident per day, including RN staffing just above the half-hour mark, but the government said a majority of the country’s roughly 15,000 nursing homes would have to add staff under the new regulation.

The new thresholds are still lower than those that had long been eyed by advocates after a landmark 2001 study funded by the Centers for Medicare and Medicaid Services recommended an average of 4.1 hours of nursing care per resident daily.

Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based advocacy nonprofit, said in a story by KFF Health News that “it is hard to call this a win for nursing home residents and families” given that the minimum levels were below what studies have found to be ideal.

KFF Health News also quoted Charlene Harrington, a professor emeritus at the nursing school of the University of California-San Francisco, saying that nursing homes had helped create the problem by taking profits at the expense of paying decent wages to care staff.

The Associated Press and AJC Reporter Carrie Teegardin contributed to this story.


Nursing Home Compare

Nursing Home Compare is the federal database for the public showing ratings for nursing homes. You can search it to find a facility.

Georgia Legal Aid

Georgia Legal Aid, a group of nonprofit lawyers, has resources to learn about and seek help with nursing homes:


Georgia law created an Ombudsman for Long Term Care to advocate for patients. Their contact information is on their website: