On February 28, 2022, the White House announced new reform measures to better the quality of care and the safety of skilled nursing facility residents, as well as to “crack down on bad actors” operating nursing homes. In his State of the Union address, President Biden called on the Centers for Medicare & Medicaid Services (CMS) to set and maintain higher standards for “sufficient staffing” of nursing homes. CMS is now conducting research to determine the minimum level and type of staffing requirements needed and plans to propose rule changes to existing regulations within the year. The effect of these policy changes is that skilled nursing facilities may face having federal funding pulled should they refuse to comply with these minimum safety standards.
California long-term care facilities are subject to a number of regulations governing the type, number, and training of staff at facilities caring for elderly adults. For example, under federal law, a skilled nursing facility “must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.” (42 C.F.R. § 483.30.) Similarly, under California law, a skilled nursing facility “shall employ an adequate number of qualified personnel to carry out all of the functions of the facility” (Health & Safety Code § 1599.1(a).)
It is well established that understaffing in nursing homes and assisted living facilities directly lead to substandard care. Understaffing contributes to and can cause avoidable illness, injury, and death, and is positively correlated with elder abuse and neglect. However, there is often a conscious decision by managers, directors, and administrators to understaff their facilities, with explicit knowledge that understaffing will negatively impact the overall quality of care provided to residents. (See, e.g., California Watch, Nursing Homes Received Millions while Cutting Staff, Wages (July 29, 2011).)