1y ago

Biden administration finalizes controversial minimum staffing mandate at nursing homes

www.cnn.com

Biden administration finalizes controversial minimum staffing mandate at nursing homes | CNN Politics

The Biden administration finalized on Monday the first-ever minimum staffing rule at nursing homes, Vice President Kamala Harris announced.

The controversial mandate requires that all nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift, according to a White House fact sheet.

Plus, nursing homes must have a registered nurse onsite at all times. The mandate will be phased in, with rural communities having longer timeframes, and temporary exemptions will be available for facilities in areas with workforce shortages that demonstrate a good faith effort to hire.

The rule, which was first proposed in September and initially called for at least three hours of daily nursing care per resident, is aimed at addressing nursing homes that are chronically understaffed, which can lead to sub-standard or unsafe care, the White House said.

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1y ago

Biden administration finalizes controversial minimum staffing mandate at nursing homes

www.cnn.com /2024/04/22/politics/nursing-home-minimum-staffing-rule/index.html

90 comments

The controversial mandate
I wonder what the controversy is...
Nursing home operators strongly objected to the minimum staffing proposal in September, saying they already struggle to fill open positions. Such a requirement could force some facilities to close.
Oh, of course, they don't want to pay people. These business owners should go back to econ 101, the labour market is just another market. If you can't get enough people at current prices, you need to PAY MORE.
Mark Parkinson, CEO of the American Health Care Association, said in a statement Monday. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis.”
Oh, it's funded. Two steps. Grab your wallet, Mark. Look in your wallet. There is your funding.
The proposed staffing mandate has also split Congress, whose approval is not required. A bipartisan Senate bill and similar legislation introduced by House Republicans would prohibit the Department of Health and Human Services from finalizing the rule.
The only time you can reliably expect the US Congress to actually do anything for their fat paychecks is when it has to prevent other people in government to do their jobs.
- Every point you made is legit, but just like psychiatric hospitals and asylums of yore, the statement you quoted is a threat that they (the profit-based company) will just stop operating certain locations if people (or the government) don't pay up. They will literally leave the elderly in the front parking lot and shut the place down if they can't keep their profit margins is what I'm reading into that statement.
  For those unaware, I'm referring to the Reagan administration coming down hard on discontinuing the funding for a lot of government funded psychiatric and elderly care facilities in the 80's. You can read the Wikipedia article, but it doesn't really address the insane power these awful and privately operated companies hold over an entire segment of the population in this country, and hold tax dollars as ransom "or else".
  That man in that quote is making a thinly veiled threat to repeat this shit again.
  
  There's a difference. Psychiatric facilities struggle with funding, nursing homes ABSOLUTELY do not. Have you seen the cost of living in even the shittiest nursing homes? It's common practice to be paying upwards of $10,000 per month, per resident. Nursing homes have all the money they could ever want, they're just greedy fucks who purposely utilize dangerously understaffed facilities to maximize profit for those at the top.
- Mark Parkinson is a trash human being. Let his name forever be dragged through shit in search engines.
- Chances are that Mark Patterson is not a medical service provider. I am sure he is very well compensated, but he would be association staff, not industry.
  
  So you are saying he's the person who is a candidate to be laid off so that they can find the money to pay their workers more?
- Oh, of course, they don’t want to pay people
  Even if they could...
  Were like 3 years deep into a nationwide nursing shortage and even hospitals can't get staffed up.
  Biden is "creating jobs" that we literally don't have qualified people to fill.
  Which is going to lead to lots of nursing homes being forced to close, and shitty nurses always having a place to land somewhere.
  You know what would help?
  If Biden had fixed our student loan shit show so more people are able to afford to be nurses.
  Like most of the headlines about Biden, it only sounds good if you don't think further than the headline.
  Down the road this causes more problems than it'll fix.
  
  Shortage? No such thing as a labor shortage. Humans are not scarce.
  Pay more, and workers will follow. If they do not follow, then it’s not worth it to them. Make it worthwhile.
  Affordability? I guarantee if you pay enough they’ll be able to afford the profession!
  
  Most of these positions do not require a college degree. They don't need RN's- a lot of these positions can be filled by high school kids. My wife and a lot of our friends in high school and college worked these jobs. My neighbor did in-home care for decades with no degree and recently chose to retire early because the pay wasn't worth staying and she makes more money buying and selling antiques at conventions now.
  How many other qualified people have been forced out of the industry due to low wages?
  Your comments on Biden seem to indicate You're either uninformed or purposefully spreading political misinformation. A quick internet search will tell you the Biden administration has forgiven $153 billion in student loans. It would be more if the Supreme Court hasn't shut down his broader cancellation measures last year.
  Is he doing everything he can? Well I've seen tons of proposals for other measures to cap the tuition costs or change federal lending, but afaik just about everything would require a bill to be passed by Congress. This may shock you, but Biden can to vote in either the House of Representatives or the Senate so you need to find your own representatives, find their stances, and write to them about this (or anything else you care about).
  Unless you have some other proposal I haven't heard of for executive action that could survive the supreme court?
  
  Reading this and your other comments, you always want to complain about everything and really don't like Biden.
  Did you vote in the 2020 primary?
  
  My sister is a nurse. Hospitals are constantly trying to put more and more workload per nurse than is feasible/safe. That sounds like it's to your point, but it isn't really. My sister was making like $25 per hour before covid. Her job was to take care of NICU babies. For $25 per hour, with a degree and a fair amount of student loan debt. And they keep adding responsibilities and assume they will work overtime "for the babies".
  Why would anyone want to go to school to get into an underpaid field where literal babies' lives are constantly in your hands, and the hospital is trying their hardest to decrease their nursing payout by decreasing nursing staff?
  We need regulation. Nurses are quitting the field because they cannot handle the stress and the pay certainly isn't worth it.
  
  trade school should be free and funded by taxes on the businesses it trains for
It's not controversial if only monied interests say so.
Good for the admin though keep pushing.
- I often go to nursing homes for medical calls, and asking for basic patient information is always a treat at the crappier ones.
  Pro-tip: when the medic asks you things like "What are we here for?", "How long have they been having this issue?", or "What's their medical history?" you don't actually have to answer. Just give a blank stare and say "I don't know, I just started my shift" or "They're not my patient". All you have to do is give the ambulance crew the patient's name and birthday, and even that's optional.
  Is the patient dead and you don't know when it happened? Say "I was talking to them a few minutes ago!" even if they're cold to the touch. Bonus points if the pt has a DNR and you don't give it to the medic.
  If all that is too much work, say "I'll go check" and find somewhere to hide until they leave with the patient -- this situation is their problem now.
  
  I work in 911 dispatch, nursing homes are one of the banes of my existence.
  Do they have any medical history we should know about?
  No.
  Oh, I guess they're just putting perfectly healthy 57 year olds in nursing homes now, good to know.
  Half of them can't tell me the address of the damn place they work, which is really nice when they call from their cell phone which barely gets any signal inside the building. Sometimes it's a crapshoot if they can even tell me the name of the facility
  For whole lot of the people who work there, at least at the homes around me, English isn't their first language, and they don't speak or understand it very well and speak with a very heavy accent. I'm not knocking them just for that though, they speak more languages than I do, and are clearly trying to make a better life for themselves, I certainly can't fault them for that, but it does make me a little concerned for their patients. If I, as someone with all of my mental faculties and hearing intact, can barely communicate with you, how effectively can they be treating and supporting patients who often have significant cognitive and/or hearing impairments?
  Don't get me started on the med techs. I'm not any kind of a healthcare professional, so I have only the vaguest idea what their role actually is in a nursing home, but from when they call 911 you would get the impression that they're kept in a dark soundproof closet until they need someone to call 911, then they're abruptly yanked out of the closet, spun around a few times, hit over the head with the phone, and told to call 911 while a strobe light flashes in their face, because they never have any idea what's going on
  Now don't get me wrong, some nursing home staff are great, they have all of the information ready when they call, they're polite, professional, everything I could hope for, but unfortunately they're kind of the exception. 90% of the time when I see a call coming in from a nursing home I need to brace myself to deal with someone who is just an absolute mess, disorganized, ill-prepared, unintelligible, uncooperative, sometimes outright rude. Sometimes I consider myself lucky if they don't just outright hang up on me halfway through the call.
  Also some of them love medical jargon, and as I said I'm not a medical professional. They'll call, rattle off a bunch of stats and vitals that mean nothing to me and aren't going in my notes even if I could type as fast as they're spitting them out. When I try to determine what the chief complaint is they'll spit out something like "their potassium is low," forcing me to ask for further clarification in plain english, so I know whether to code it as a cardiac thing, a respiratory thing, etc.
  
  These are great tips. Can we adapt them to other industries? Maintaining information directly related to your employment is just so difficult and inconvenient at times.
They shouldn’t give exceptions for “good faith effort to hire.” If you can’t hire someone, clearly you aren’t matching what the market demands and need to improve working conditions and pay.
Just like “emergency certifications” in teaching, when the solution to “we don’t have enough qualified people” becomes letting any one with a pulse in, we end up with a race to the bottoms in employee qualifications, pay and working conditions.
You cannot expect someone go through years of school, with additional specialized training, sometimes even masters or doctoral level degrees, to work for substandard wages. In the medical field especially - the mobile and qualified can make bank as travel nurses, why would they bother with you?
If there are too many patients, can that Texas politician's grandma give up her life for the economy?
(99% positive the politician was from Texas. Pretty this statement wasn't from Ted Cruz, but maybe. During COVID saying that grandmas in nursing homes would give up their life to open up lockdowns to restore the economy.)
- You are thinking of Dan Patrick, he is the Lt. Governor making him the 2nd biggest cunt in Texas right behind Abbot but ahead of Paxton and Cruz. Though, one could argue that the biggest piece of shit stuck to the bottom of Texas's shoe is Paxton I prefer to lump all 4 in the same bag of dicks.
  
  Thanks.
  Yeah, they are just different faces of the same evil.
Isnt a big reason the rail workers had such shitty schedules us because they are understaffed as well?
- Correct. They need to strike a hell of a lot harder, and Biden needs to back the union harder. The owners of the rail companies are selfish greedy pigs.
I worked on skilled nursing facilities insurance during the pandemic. Mostly a horror show by owners who don't GAF about your grandpa and would rather spend money on their personal vehicles than invest in adequate staffing and maintenance. Disgusting group of people.
I'm curious how they came up with 3.48 hours. Does rounding it up to 3.5 really make that much of a difference?
- They're probably working with larger numbers of hours, like in terms of years, and compromises then lower the numbers that later get divided back down into fractional hours.
At first I was like "wait, how is this controversial?"
FTA:
"Nursing home operators strongly objected to the minimum staffing proposal in September, saying they already struggle to fill open positions. Such a requirement could force some facilities to close."
There are two options for a nursing home in this position:
Hire more people.
Reduce the number of patients.
But here's the damned part of it... if they shed patients, or just flat out close up shop, all those patients have to go SOMEWHERE and now that's going to stress OTHER facilities who will need to... yup... hire more or reduce the number of patients.
FTA:
"a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift"
Has anyone done the boomer math here?
https://acl.gov/ltc/basic-needs/how-much-care-will-you-need
"Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years
Women need care longer (3.7 years) than men (2.2 years)
One-third of today's 65 year-olds may never need long-term care support, but 20 percent will need it for longer than 5 years"
Woof. 76.4 million boomers.
https://www.prb.org/resources/just-how-many-baby-boomers-are-there/
2-3% of that for registered nurses.
10-11% for nurse aides.
2% additional nurse staff.
So as much as 15% of the population needed just for nursing staff?
70% of 76.4 million = 53,480,000 boomers needing nursing home care.
15% of 53,480,000 = 8,022,000 nursing staff needed, JUST for the nursing homes.
https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet
"Nursing is the nation's largest healthcare profession, with nearly 4.7 million registered nurses (RNs) nationwide. Of all licensed RNs, 89% are employed in nursing."
Now that's just RNs and we only need 2-3% for RNs, but that is still 1,604,400 just dedicated to nursing homes, or about 1/4 of all nurses.
https://www.statista.com/statistics/185144/persons-employed-in-us-nursing-care-facilities-since-2000/
"This statistic shows the number of persons employed in U.S. nursing care facilities from 2000 to 2022. In 2022, there were approximately 1,280,000 persons employed in nursing care facilities all over the United State, a significant decrease compared to previous years."
Note, that figure is a fraction of what would be needed and that's ALL nursing home staff, not just the nurses.
This is a great IDEA, and nobody wants nursing home residents living in squalor, but I just don't see how that mandate is achievable... unless someone puts Boston Dynamics robots through nursing schol...
https://youtu.be/29ECwExc-_M
- Pay higher wages
  Improve working conditions
  The reason they struggle to fill these positions is because of how terrible they treat their front-line staff
  
  That AND there aren't enough qualified people in the pipeline to fill all the positions that need to be filled.
  
  People keep yapping about the wages, meanwhile RNs where I work are taking home $458 per hour. How much more do you propose we offer them, since their pay runs our hospital over $1.25 million per month as is, and they are making more than the general surgeons.
- Your math is... Difficult to follow, to say the least.
  
  tl;dr We need nurse robots!
- 15% of 53,480,000 = 8,022,000 nursing staff needed, JUST for the nursing homes.
  It seems you're making the assumption that all these baby boomers will need care in a nursing home at the same time. This doesn't seem reasonable at all given there's an 18 year age range among boomers.
  
  Granted it's not going to happen all at the same time, but when the oldest ones have died off, the oldest GenX'ers (me) will start qualifying.
  Regardless if the number is 8 million nurses, 1 million nurses, or something in between, we don't have enough people working the jobs or in the pipeline to meet this mandate.

90 comments