Nursing Facility Staffing Shortages – from bad to worst!

The disproportionate impact of the COVID-19 pandemic on nursing facility residents and staff has brought increased attention to long-standing workforce issues that can affect care quality and safety, such as staffing shortages and high turnover rates. These issues have existed for decades and have been associated with adverse outcomes, including increased mortality rates, hospitalization rates, and emergency department visits. Since the onset of the pandemic, more than 200,000 COVID-19 deaths have occurred among long-term care residents and staff, with most of these deaths (150,000 COVID-19 deaths) occurring among residents and staff in nursing facilities that are certified to receive Medicare and/or Medicaid payments. In response to these issues, the Biden Administration recently announced a set of nursing facility reforms, which were highlighted in the State of the Union address.

What do the data show about nursing facility staffing?

  • As of the week ending February 27, 2022, the most recent data available, 29% of nursing facilities reported at least one staffing shortage (approximately 4,000 out of 14,000 facilities)
  • Nursing facilities were most likely to report a shortage of aides and least likely to report a shortage of clinical staff as of February 27, 2022
  • The share of nursing facilities reporting staffing shortages varies widely by state

What new policies did the Biden Administration announce?

  • Propose new regulations that would establish a minimum nursing facility staffing requirement within the next year
    • establishing minimum staffing levels for Medicare and Medicaid-certified nursing facilities
    • strengthening oversight of poor-performing nursing facilities
    • supporting state efforts to tie Medicaid reimbursement rates to increases in staff compensation
    • launching a national nursing career pathways campaign to recruit, train, and retain long-term care staff
  • Initiatives are focused on improving care quality, nursing facility oversight, data transparency, career pathways, and pandemic and emergency preparedness

What issues are important to watch?

  • Questions remain about how and when the new Biden policy proposals will be implemented
  • How the pandemic and CMS’s health care provider vaccination mandate will affect nursing facility staffing shortages

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