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The Time is Now: Nursing Home Staffing Ratios Addressed

Fergus Falls Daily Journal - 5/6/2024

May 6—A final ruling was released from the Centers for Medicare and Medicaid Services recently on something that has continually plagued care facilities in rural areas of western Minnesota, Otter Tail County and nationwide: Minimum staffing ratios.

The lengthy report detailing the changes in the final ruling cited a few criteria that are now mandated for long term care facilities.

According to LeadingAge Minnesota, CMS mandates increasing the time that providers must provide care from a three-hour per resident day standard to a 3.48-hour standard.

In addition, the first three hours must be covered by a registered nurse (.55 hours per resident per day) and CNA (2.45 hours per resident per day). Settings can use any combination of nurse staff (including LPNs) to meet the remainder of the time requirement.

The biggest change is the requirement that long term care facilities now have an onsite registered nurse staffed 24 hours a day, seven days a week in most cases.

LeadingAge notes that some nursing homes may be exempt from having RN coverage for up to eight hours in a 24-hour day under certain circumstances. A director of nursing can also count towards compliance with the rule.

According to a press release from CMS, it will address a standard of care: "This final rule was informed by the feedback CMS received from over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within long term care facilities."

As for implementation, CMS states that the final rule provides a staggered implementation timeframe of the minimum nurse staffing standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors.

In addition to the rollout, CMS also took into consideration the effect of minimum staff ratios in smaller and rural long term care facilities and the ability to hire enough workers and plans to keep a close eye on how things develop and what would technically be the definition of a "rural" facility.

According to LeadingAge, one of the surprising developments with the final ruling was receiving it despite hearing from numerous providers that such a standard would most likely not be attainable with the current and ongoing labor shortages.

It's unclear at this time how the ruling will affect local providers.

The ruling can be read in its entirety online at:


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