Would your nursing home meet Biden's proposed staffing levels? Check our data to find out.
Most of the nation’s nursing homes would have to increase their staffing levels under regulations the Biden administration proposed on Friday, although the gap varies significantly between states and by job.
Over the first 90 days of 2023, only 141 of the nation’s nearly 15,000 skilled nursing facilities – less than 1% – met two core standards of the draft rule, according to a USA TODAY analysis of daily time card data that nursing homes give to regulators.
On average, facilities met the proposed minimum for registered nurses (RNs) about half of the time. They had enough certified nursing assistants (CNAs, or aides) less than a third of the time. And both standards were met one of every six days.
Decades of academic research show that staffing levels predict the quality of care in nursing homes. Minimums like those proposed are intended to limit resident neglect or delays in care. Fulfilling individual care plans often demands even more staffing.
Several southern states had the biggest deficits in average daily staffing levels for RNs. Many also ranked poorly for their number of aides.
Three new rules anchor the nursing home staffing proposal
Existing rules require nursing homes to provide “sufficient” staffing to meet all needs outlined in each resident’s care plan, a standard that would continue. The proposed regulations would make three primary revisions. Nursing homes would need to:
- Have a Registered Nurse (RN) on duty 24/7. Current rules require 24/7 care but allow a Licensed Practical Nurse (LPN) to meet the requirement.
- Ensure RNs provide a daily average of at least 0.55 hours of care to each resident. RNs write individual care plans, monitor changes in condition and write orders for treatment that are carried out by other licensed nurses and by aides.
- Ensure Certified Nursing Assistants (CNAs, or aides) provide a daily average of at least 2.45 hours of care to each resident. Aides assist residents with “activities of daily living” such as toileting, bathing and eating.
How many nursing homes met the proposed standard?
Public data does not make it possible to know if RNs worked around the clock, but the map below shows how often each nursing home met the per-resident RN and CNA standards in the first 90 days of 2023, the most recent information available. Zoom in and click on a dot to see each nursing home's data.
Yoonsek Pyun|USA TODAY
If you don't see an interactive map, you can find it here.
Which states are the farthest from meeting the proposed rules? And the closest?
In Louisiana, nursing homes had enough RNs to comply with the draft rule on an average of 5 days out of 90 with a typical day falling short by half. The next lowest were Oklahoma with an average of 14 days, Texas (15 days), Arkansas (15 days) and Missouri (24 days).
In contrast, facilities in Alaska, Hawaii, D.C., Puerto Rico and Utah met the standard at least 78 of the 90 days on average.
Texas facilities most often fell short of the proposed minimum for certified nursing assistants, meeting the requirement just 11 of 90 days on average. The next lowest were Tennessee (12 days), Ohio (13), Virginia (14) and Georgia (14).
In contrast, facilities in Alaska, Oregon, Maine, North Dakota and Hawaii met the standard at least 53 of the 90 days, on average.
How soon could the rules take effect?
The changes would be phased in over five years to give nursing homes, particularly those in rural areas, time to hire more staff. Facilities also could ask for a hardship exemption that would allow them to maintain their Medicaid or Medicare license even if they do not meet the requirements.
What are the criticisms about the proposal?
Most advocates for nursing home residents are glad to see staffing minimums adopted after decades of research showing more caregivers are needed – but they worry that the bar has been set too low and that a lack of enforcement will render them meaningless.
A USA TODAY investigation found that although nursing homes have for years submitted daily staffing data to federal officials, they rarely are punished for violating the existing guidelines and rules. Penalties were rare even at facilities where inspectors noted low staffing while investigating avoidable deaths, broken bones, days without assistance to leave bed and hours sitting in feces, among other violations. Fines are even rarer.
Industry officials say the rules are too simple to make sense for a field as complex as health care and that there simply are not enough workers to meet these proposed requirements.
Learn More:Thousands of nursing homes would have to add workers under Biden plan to make them safer
How do I share my opinion about the proposed nursing home staff regulations?
Read the full proposal in the Federal Register, where the public can share their thoughts with regulators starting Wednesday. Comments will be accepted through early November and then reviewed before the regulations are finalized or adopted.