Attorney General Bonta Co-Leads Coalition in Supporting Biden Administration’s Efforts to Set Minimum Staffing Requirements in Nursing Homes

Tuesday, November 7, 2023
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Urges CMS to go further to better protect skilled nursing facility residents

OAKLAND – California Attorney General Rob Bonta is co-leading a coalition of 15 states in submitting a comment letter supporting the Biden Administration’s proposed rule that seeks to establish nationwide comprehensive staffing requirements for skilled nursing facilities (SNFS). The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services' (CMS) proposed rule would set the first national minimum standards for staffing levels at nursing homes and other long-term care facilities, to ensure that long-term care residents across the nation receive the quality care they need. In the comment letter, the attorneys general commend the proposed rule and urge HHS to further increase the minimum standard.

“Eliminating the staff shortages that plague nursing homes is a crucial step to ensuring patients receive the quality care they deserve,” said Attorney General Bonta. “California has been at the forefront of implementing minimum staffing levels for skilled nursing facilities, and we stand in strong support of enacting federal protections across the nation. While the proposed rule would establish essential minimum national staffing standards, we’re urging the Biden administration to further raise the minimum standard to ensure our elderly communities can age with dignity. At the California Department of Justice, we will continue to hold nursing homes accountable and ensure that all residents receive safe and high-quality care that they deserve.”

Under the rule, CMS will require nursing homes participating in Medicare and Medicaid to have a registered nurse on site 24/7 as well as a minimum number of daily hours of direct care to residents provided by both registered nurses (RNs) and certified nurse assistants (CNAs). However, in the comment letter, Attorney General Bonta urges HHS to further strengthen the minimum staffing standards, arguing that the proposed standards for RNs, CNAs, and licensed practical nurses (LPNs) are still too low to protect this critically vulnerable population. The coalition urges CMS to adopt a minimum requirement of 4.1 hours per resident day (“HPRD”), comprised of 2.8 HPRD for CNAs, .75 HPRD for RNs, and .55 HPRD LPNs. This standard, which is supported by academic research, is necessary to avoid preventable resident neglect and suffering.

The attorneys general also provide suggestions to strengthen the implementation of the rule based on the coalition states’ experience protecting their residents, including:

  • Increasing the minimum standard for nurse staffing hours to improve patient outcomes, reduce staff burnout, and enhance patients’ quality of care. During the COVID-19 pandemic, higher nursing hours were associated with fewer deaths and fewer COVID cases. Federal actions to incentivize higher staffing levels have successfully improved staffing levels, proving the need for national minimum nurse staffing standards.
  • Making it easier for consumers to search for and compare nursing homes by prominently showing a facility's staffing numbers and compliance with the new standards below the staffing rating on the Care Compare website. This change would enable prospective residents and family members to easily assess whether the facility will meet their needs for staffing levels.
  • Adding more stringent eligibility criteria and limitations for exemptions from any staffing requirements that long-term care facilities seek.

Joining Attorney General Bonta in filing the comment letter are the attorneys general of Arizona, Delaware, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, and Vermont. 

A copy of the comment letter can be found here.

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