The Biden administration proposes new federal standards for nursing home care
In his State of the Union address, President Joe Biden made a promise to "protect seniors' lives." And he's following through on that promise with his latest push to ensure that nursing homes, serving 1.2 million seniors, are sufficiently staffed around the clock.
On Sept. 1, the Biden administration issued a proposal to establish comprehensive staffing requirements for nursing homes across the country. The President, alongside the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), has proposed a minimum nursing staff standard for facilities participating in Medicare and Medicaid.
Since the start of the pandemic, more than 200,000 residents and staff in long-term care facilities have died because of COVID-19.
"That's unacceptable," Xavier Becerra, the secretary of HHS, told Morning Edition.
Roughly three quarters of long-term care facilities would have to hire additional staff to meet the administration's requirements, CMS estimates.
"It's a big change in the sense that the industry hasn't had to follow particular standards," Becerra said. "And it's been the wild, wild west when it comes to quality and accountability at nursing homes throughout the country. What we're simply saying is we don't want [the] wild, wild west when we send our loved ones."
Nursing is inevitably a demanding job, and it has been widely regarded as one of the most stressful occupations, according to the National Library of Medicine. The profession is associated with high levels of staff turnover, absenteeism and levels of burnout.
In an attempt to improve nurse retention rates and attract more people to the industry, CMS would work with private sector partners, investing over $75 million in financial incentives, such as tuition reimbursement.
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Transcript
STEVE INSKEEP, HOST:
President Biden's administration wants more staff to be caring for people in nursing homes. The Centers for Medicare and Medicaid Services are changing the requirements for staff whenever Medicare is paying the bills. Xavier Becerra is secretary of the Department of Health and Human Services, which is overseeing this change. Mr. Secretary, welcome to the program.
XAVIER BECERRA: Thanks, Steve, for having me.
INSKEEP: So I get the principle. I have loved ones in nursing homes. I want them to be well taken care of. And you're saying there should be more staff on hand in most nursing homes. But how big a change is this, really?
BECERRA: It's a big change in the sense that the industry hasn't had to follow particular standards, and it's been the wild, wild West when it comes to quality and accountability at nursing homes throughout the country. What we're simply saying is, we don't want wild, wild West when we send our loved ones - when you, Steve, send your family members or saw them there, you want to make sure they're getting due care and their - the safety is there. That's all we're asking for is accountability.
INSKEEP: With that said, and granting that it seems that most nursing homes would have to add staff, it seems that many of them would only add a few people, a little. Is it really going to be that much of a change that people would notice when they're visiting or in a nursing home?
BECERRA: Well, if they're not having to make much change, then hopefully that means that they're actually offering quality services. But as we saw with COVID, some 200,000 residents at nursing homes and workers at nursing homes died during this pandemic. That's unacceptable. Something was going on. We've heard people saying this for quite some time, and so it's time to act. Residents demanded, families of residents demanded and taxpayers demanded - because this is an industry that receives about $100 billion in federal taxpayer dollars when they apply for some help with reimbursement of costs.
INSKEEP: I've been interested in some of the reactions to this announcement. The industry itself has said they could use even more staff than you are requiring them to have, but they're also saying the U.S. is not going to help them pay for additional staff. How do you respond to that?
BECERRA: Well, it's interesting. First, we do value all opinions, and that's what we sought when we were trying to craft this rule. And now that the rule is public and we have an open comment period for the rule, we welcome all opinions.
Again, the bottom line - we need to enact enforceable standards for nursing home industry. And if it were that tough, then someone's got to explain to me why Wall Street, private equity firms are seeing this as a lucrative market to go into and buy up some of these nursing homes. So something's going on. We know that too many people have died or not had a good outcome at nursing homes, and where they are having good outcomes, we want to elevate those nursing homes. But everyone should meet certain standards. Residents demand it. So do taxpayers.
INSKEEP: It sounds like your position is there's plenty of money in the system. They don't need more money from the federal government. The average nursing home can afford to hire the extra two or 10 or 20 or 50 people.
BECERRA: What we are providing in this rule, we're calling for an additional $75 million to help both train and retain nursing home staff. There is no doubt that the health care services industry overall - hospitals, nursing homes, you name it - are having difficulty with particular staffing levels. Nurses are in big demand, no doubt. But at the same time, we think that if we can improve working conditions and if we can require that at least one nurse be on staff 24/7 at a nursing home - if you're going to call yourself a nursing home, you should have at least one nurse available at any time that you're operating. We think it's time to get to these standards.
INSKEEP: Briefly, is there a special problem or a special risk with some of the smaller, more rural, more marginal facilities?
BECERRA: Well, that's why we use something other than a one-size-fits-all approach here. We're going to phase this rule in. Rural communities have a harder time. And so we're trying to address those concerns of some of those facilities - smaller nonprofit facilities, rural facilities. So it will be an enforceable standard, but one that accommodates the needs of an industry that's very important.
INSKEEP: Mr. Secretary, it's a pleasure talking with you. Thank you very much for your time.
BECERRA: Thanks, Steve.
INSKEEP: Xavier Becerra is secretary of the Department of Health and Human Services. Transcript provided by NPR, Copyright NPR.
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