Nursing home staffing mandate would save thousands of lives, researchers say

A new federal rule could save nearly 13,000 lives a year, researchers say, despite pushback from nursing home officials who argue the updated staffing standards could lead to home closures.

At the request of Sen. Elizabeth Warren, D-Massachusetts, University of Pennsylvania researchers estimated the number of lives that would be saved under the Biden administration's finalized minimum staffing rule for nursing homes. The researchers said fully implementing the Center for Medicare & Medicaid Services' staffing rule would result in 12,945 fewer deaths yearly.

The number of lives saved by implementing the staffing rule would be "staggering," Warren said.

"It’s shameful that the nursing home industry would rather line its own pockets than follow these standards, provide better care, and save lives," Warren told USA TODAY.

Industry groups representing nursing homes said the federal staffing minimum would place an undue burden on homes that already struggle to fill shifts during a nationwide nursing shortage.

The Penn estimates do not address whether nursing homes might be forced to close as a result of the new regulation. Such a disruption could force residents to find another home.

Administration sets minimum staffing levels; industry sues

In April, the Biden administration announced a new rule requiring nursing homes that get federal payments to meet minimum staffing requirements for registered nurses and nurse aides. Under the rule, nursing homes must provide each resident a daily minimum of 0.55 hours of care from a registered nurse and 2.45 hours from a certified nursing assistant. Each resident would get at least 3.48 hours of nurse care daily, and a registered nurse would staff homes at all times.

The rule will be phased in beginning next month; homes will have until May 2026 to meet the staffing ratios.

In May, nursing home groups sued the U.S. Department of Health and Human Services and CMS in an attempt to block the rule, arguing the pricy staffing requirements would prompt nursing homes to close.

The American Health Care Association and the Texas Health Care Association stated in a federal lawsuit in the Northern District of Texas that it makes no sense" to mandate a 24/7 registered nurse requirement and "rigid staffing ratios on thousands and thousands of nursing homes across the country."

"If CMS’s new standards are permitted to take effect, hundreds of nursing homes will likely be forced to downsize or close their doors entirely," the lawsuit says. "That threatens to displace tens of thousands of nursing home residents from their current facilities, while forcing countless other seniors and family members to wait longer, search farther, and pay more for the care they need."

Nursing homes currently fall short

AHCA estimates nursing homes would need to hire more than 100,000 registered nurses and nurse aides at an annual cost of $6.5 billion to comply with the federal requirements.

The University of Pennsylvania researchers noted that 83% of U.S. nursing homes had overall staffing levels in the first half of 2023 that were below the minimum requirement.

Dr. Rachel Werner, a professor of health care management and economics at the University of Pennsylvania, said the analysis relied on earlier research that estimated how total nurse staffing hours can affect mortality rates. Her team examined how death rates would change under the more robust staffing required by the new rule. Based on that review, she and a colleague concluded enforcing the CMS rule would save 12,945 lives per year.

Werner said patient safety hazards at inadequately staffed homes are well documented. She cited incidents such as medication errors, patient falls going undetected and dangerous pressure sores that developed on patients who remained in their beds for hours without being turned.

"There's a number of ways in which understaffed nursing homes increase the number of mistakes and decrease individual attention to nursing home residents that ultimately affect mortality," Werner said.

Werner said nursing homes can be exempt from the staffing rule if they are located in a designated workforce shortage area.

Questions about nursing home safety surfaced when more than 200,000 nursing home residents and staff died from COVID-19 in 2020 and 2021, the first two years of the pandemic.

In May, Warren, Bernie Sanders and Richard Blumenthal along with Reps. Jan Schakowsky and Lloyd Doggett sent letters to executives of three large chains , questioning the nursing homes' spending on executive compensation, stock buybacks and dividends after the industry protested the staffing rule.

Ken Alltucker is on X at @kalltucker, contact him by email at alltuck@usatoday.com .

This article originally appeared on USA TODAY: Nursing home staffing mandate would save thousands of lives, researchers say