Recently, U.S. Sens. Bob Casey (D-PA) and Ron Wyden (D-OR) led a letter to Center for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure encouraging the agency to finalize and implement the Biden administration’s new proposed rule to address the nation’s nursing home staffing crisis. 

The new rule directs CMS to establish minimum staffing requirements for nursing homes, which the senators have long called for as an important step to promote safety and quality care for nursing home residents.

Excerpts from the letter follow.

Our nation’s 1.2 million nursing home residents deserve high-quality care that prioritizes their safety. The proposed rule takes a vital step towards ensuring residents receive this high-quality care by establishing commonsense staffing minimums and improving enforcement… 

We understand that developing a meaningful minimum staffing requirement involves the careful evaluation of complex and nuanced variables, such as variations in acuity levels and case mix, as well as the special circumstances of rural and underserved communities and the staff and resources available to them. 

In the proposed rule, CMS has proposed minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for registered nurses (RNs) and 2.45 HPRD for nurse aides.”

The letter called for minimum staffing of licensed practical nurses as well. LPNs provide essential bedside care to nursing home residents, and they are critical to the operation of America’s nursing homes. We urge CMS to include LPNs in the final rule… 

The proposed rule also requires that an RN be onsite 24 hours a day, seven days a week. Current law requires nursing homes to have an RN onsite eight hours a day and a licensed nurse onsite 24 hours a day. 

The Nursing Home Staffing Study, commissioned by CMS, found in a literature review that all but one safe staffing study supported a 24/7 RN requirement. 

We support CMS’s historic proposal to establish a 24/7 RN staffing requirement in nursing homes as a critical measure to protect resident safety. 

We appreciate the recognition in the proposed rule that staffing minimums may be difficult to implement in some areas of the country, such as rural areas, given challenges in recruiting and retraining nursing staff. We encourage CMS to collect stakeholder input and incorporate flexibilities that reflect differences in workforce availability, facility size and resident demographics as the agency finalizes the rule. Specifically, we know that some facilities will struggle to meet a 24/7 RN requirement… We urge CMS to provide for strong enforcement of a final staffing standard while ensuring state survey agencies and their staffs are adequately resourced to conduct this important work.”

The letter was signed by 10 other senators. 

In February 2023, Sen. Casey called on the Biden administration to implement minimum staffing standards in nursing homes and applauded the announcement of the new rule in September. Sen. Casey released a report in May 2023 detailing the crisis in nursing home oversight due to severe staffing shortages at state survey agencies. 

Read the full letter at www.bit.ly/3soNhOL. 

U.S. Sen. Bob Casey (D-PA) is the chairman of the U.S. Senate Special Committee on Aging, and Sen. Ron Wyden (D-OR), is the chairman of the U.S. Senate Committee on Finance. The letter was signed by Sens. Patty Murray, Bernard Sanders, Elizabeth Warren, Richard Blumenthal, Sherrod Brown, Catherine Cortez Masto, John Fetterman, Edward Markey, Jeffrey Merkley and Chris Van Hollen.