Nurses Push for Staffing Requirements at Nursing Homes

Nursing home operators who have been lining up in opposition to a Biden Administration proposal to establish minimum staffing levels for resident care in nursing homes—a proposal they say would add more than $11B a year to their operating costs—now are seeing nurses lining up to demand minimum staffing levels as a basic working condition.

Margins at skilled nursing facilities have been squeezed by rising costs and labor shortages as occupancy levels recovered last year. A nationwide shortage of nurses that pre-dated the pandemic was greatly exacerbated when overworked nurses joined the Great Resignation.

Now, the remaining nurses in the workforce are throwing down the gauntlet at hospitals and nursing homes over staffing levels they say are inducing burnout and causing more nurses to leave the profession.

The quick settlement last week of a three-day strike by nurses at two of NYC’s largest hospitals, Montefiore and Mount Sinai, may turn out to be a template for what nurses increasingly say is their top demand—a higher priority to them than increased wages—establishing a ratio of patients to nurses.

The New York State Nurses Association (NYSNA), which represents an estimated 7,000 nurses who work at the two hospitals, announced a deal to establish set nurse-to-patient ratios for all in-patient and emergency units at both hospitals.

NYSNA said the deal will end conditions that have forced nurses to cover up to 20 patients at a time and guarantees there will “always be enough nurses at the bedside to provide safe patient care, not just on paper.”

In November, the Biden Administration said it will propose a minimum staffing level for nursing homes based on a 2001 recommendation from the Centers for Medicare and Medicaid Services that nursing homes deliver at least 4.1 hours of nursing care to every resident every day, the equivalent of one nurse for every seven residents on day and evening shifts.

Last month, the American Health Care Association estimated that the 4.1 hour per day care standard would add $11.3B annually to cost of operating the nation’s 15,500 nursing homes—and require an additional 191,000 nurses and nurse aides.

Nurses aren’t the only essential nursing home workers complaining about burnout from staffing shortages. Nursing home administrators are warning that a non-stop requirement to conduct federal surveys of patient care for Medicare and Medicaid is pushing many of them over the edge.

Surveyors of nursing home care for the federal programs can issue citations resulting in non-compliance penalties during surveys, which then triggers a process that can result in three or four surveys in a row. During the pandemic, the skilled nursing industry paid an estimated $500M in non-compliance penalties, according to CMS data.

A lead administrator of an SNF in Wisconsin who recently resigned told Skilled Nursing News that what she called “onerous and punitive” federal surveys induced her to quit.

“I resigned my position because I was completely burned out. I was working at least 12-hour days every single day, working the floor as a CNA as well, in addition to doing the administrator job because of short staffing,” she told SNN. “Having three or four surveys in a row, back to back, with no break in between was absolutely and utterly exhausting.”