Nursing Home Staffing Rules Eased During Virus Go Back in Effect

The Trump administration is once again requiring nursing homes to submit payroll-based staffing data to federal regulators to provide a more accurate assessment of workforce levels during the Covid-19 pandemic.

The move, announced Thursday by the Centers for Medicare & Medicaid Services, ends a waiver that temporarily allowed the facilities to provide self-reported staffing data. The waiver, announced in early March, was designed to reduce administrative requirements so the facilities could concentrate more resources on stopping Covid-19 infections and deaths during the public health emergency.

The agency said approximately 60% of facilities still submitted payroll data despite the waiver.

The waiver was lifted as several witnesses testified at a House Ways and Means Committee hearing that without accurate payroll data, regulators can’t determine if nursing homes are meeting federal staffing requirements during the pandemic.

The Covid-19 outbreak has killed more than 50,000 U.S. nursing home residents and more than 500 staffers, David Grabowski, a Harvard Medical School professor, testified.

Under the new guidance, nursing homes that accept Medicare and Medicaid patients must submit payroll-based staffing data for the second quarter—April through June—by Aug. 14. The agency is also encouraging, but not requiring, facilities to submit similar payroll-based data covering the first three months of 2020.

Federal law requires that nursing homes provide “licensed nursing services” that are “sufficient” to meet resident needs. But Medicare only requires nursing homes to have at least one registered nurse on duty for eight straight hours per day.

A 2019 study by researchers at Harvard University found 70% of nursing homes self-reported higher staffing levels than were reflected in payroll data provided to the Centers for Medicare & Medicaid Services.

Overall, more than half of facilities met the expected staffing levels less than 20% of the time.

Staffing levels for registered nurses, licensed practical nurses, and nurse aides typically dropped off at night and on weekends. They also peaked in the weeks before and during state inspections before dropping off afterward.

The staffing shortfalls were worst for registered nurses who have the most training and who supervise other caregivers. The study found 91% of facilities met CMS-expected staffing levels for registered nurses less than 60% of the time.