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US nursing homes face stricter staffing rules under new federal mandate

A sweeping overhaul demands more nurses and aides—but most facilities are unprepared. Can states fill the gap before penalties hit?

The image shows a poster with two photos of nurses on the left side and text on the right side. The...
The image shows a poster with two photos of nurses on the left side and text on the right side. The text reads "Nurses Week 2020: Compassion, Expertise, Trust" and there is a logo at the bottom right corner.

US nursing homes face stricter staffing rules under new federal mandate

New federal rules now require nursing homes in the US to meet stricter staffing levels. The changes, announced by the Centers for Medicare & Medicaid Services (CMS) on 22 April 2024, aim to improve care quality for residents. Currently, fewer than 20% of facilities meet these standards.

Pennsylvania has already taken steps ahead of the deadline. By 1 July 2024, its nursing homes must provide at least 3.2 hours of care per resident each day.

The CMS final rule sets a phased approach for compliance. Within two years, nursing facilities must deliver 3.48 hours of care per resident daily, including round-the-clock registered nurse (RN) coverage. By the third year, stricter targets will apply: 0.55 hours of RN care and 2.45 hours of nurse aide support per resident per day.

Facilities also face tighter assessment rules. They must comply with enhanced resident evaluations within 90 days of the final rule's publication. To tackle staffing shortages, officials are exploring new solutions. One proposal would grant high school students academic credit for working in nursing homes. Meanwhile, CMS has already invested over $75 million—allocated in September 2023—to boost staffing levels. In the coming months, states will need to report how much of their Medicaid budgets goes toward direct care worker wages. This transparency measure aims to ensure funding reaches frontline staff.

The updated regulations mark a significant shift for nursing home operations. Facilities must now meet higher staffing thresholds or risk penalties. With most currently falling short, the industry faces a race to recruit and retain enough workers before deadlines arrive.

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