CMS' Staffing Proposal Will Cost Nursing Homes $6.8B for 102K Nurse Hires, Industry Backed Report Finds

Fierce Healthcare | By Dave Muoio

Meeting the Biden administration’s minimum staffing proposals for nursing homes would require facilities nationwide to hire more than 102,000 additional nurses at a cost of $6.8 billion, well above the government’s $4 billion estimate, according to a report released Tuesday by an industry group. 
 
“That is money that is simply not out there,” Mark Parkinson, president and CEO of the American Health Care Association (AHCA) and its sister organization the National Center for Assisted Living, said during a press event Tuesday. “Even at the administration’s number of $4 billion—that’s almost $400,000 per nursing facility, and nursing facilities just don’t have that money. They will not be able to implement this proposal.”
 
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) floated a plan to require participating nursing homes to provide a minimum of 0.55 hours of care from a registered nurse per resident per day, 2.45 hours of care from a nurse aide per resident per day and have at least one registered nurse on-site at all times.
 
The proposal was widely panned by AHCA and other industry groups, which said that many of their facilities are financially underwater and already struggling to find workers. Healthcare labor costs have increased in recent years due in part to the low, but somewhat improving, supply of clinical workers. 
 
The new analysis—conducted on behalf of AHCA by professional services firm CliftonLarsonAllen (CLA)—sought to measure the gap between current nursing home’s current staffing and the burden full compliance would require using “more up-to-date” 2022 cost reports that reflect rising wage growth, Cory Rutledge, chief assurance officer at CLA, told reporters.
 
To date, 94% of nursing homes are falling short of at least one of CMS’ proposed staffing requirements while 36% are falling short of all three requirements, according to the report.
 
While about 60% of nursing homes nationwide are already in the red, Rutledge noted that the compliance burden would be heavier among the facilities more reliant on government funds. On average, facilities that currently fall short of all three requirements counted 56% of their total patient days from Medicaid patients, whereas those that did meet the criteria had a 43% Medicaid census.
 
Nursing homes’ alternative to more hires would be to trim down the number of residents they’re caring for. In a hypothetical where nursing homes collectively took this route, CLA found that more than 287,000 nursing home residents, or about 26% of the national total, would be impacted.

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Home Health Pays Highest for PT, OT, Compensation Report Finds

McKnight’s Home Care | By Am Healy
 
Working for home health agencies is more lucrative for physical therapists and occupational therapists than other long-term care employers, according to data from the Hospital & Healthcare Compensation Service (HCS) Rehabilitation Salary & Benefits Report for 2023.
 
From July 2022 to June 2023, home health agencies paid the highest rates for PT services, at $48.67 per hour, on average. Hospital and long-term care (LTC) settings paid $46.68 and $45.89 per hour, respectively. However, pay rate increases were the slowest in home health settings, increasing by only 3.2% while rates grew at 3.5% in hospitals and 3.7% in LTC.
 
For occupational therapists, home health agencies paid $45.94 per hour, while hospitals paid $44.08 and LTC paid $42.75 per hour, on average. 
 
Rates varied by state. Home-based physical therapy received the highest hourly rates in New York, at $58.50 per hour, whereas Minnesota saw the lowest rates at $42 per hour.
 
Home health agencies also offered other benefits to physical therapists and occupational therapists. More than 93% of those surveyed offered paid time off, and on average, PT and OT workers earned about two weeks of PTO upon receiving employment. The vast majority offered time-and-a-half or double-time pay for holidays worked.
 
More than 90% of these agencies also offered continuing education and tuition assistance opportunities to PT and OT workers, even for those paid hourly. Almost 100% offered retirement plans, and 85% matched employees’ contributions. All of the home health agencies surveyed offered health insurance to employees, and most extended coverage to dependents. Vision and dental insurance were also offered by all of those surveyed.
 
To gather this data, HCS analyzed a total of 2,600 care providers, including LTC facilities, hospitals and home health agencies. Two years ago, pay growth for PT services in home health settings lagged behind hospitals and LTC. The same HCS report from 2021 found that home health agencies may use higher wages as a tool to offset challenges brought about by staffing shortages felt across the entire healthcare industry.

Pain: Considering Complementary Approaches (eBook)

National Center for Complimentary and Integrative Health (NIH)

Many people use complementary health approaches—such as acupuncture, yoga, or massage therapy—to help them manage painful conditions.

We have a 50-page eBook that provides an overview of complementary health approaches that people use for pain. The eBook has brief summaries of what the science says about whether each approach is useful and safe, as well as tips to help you be an informed consumer.

Download e-book

NEW RESOURCES AVAILABLE: Cue Cards for Administering the BIMS in Writing, PHQ-2 to 9, Pain Assessment Interview, and Interview for Daily and Activity Preferences

CMS is offering a set of cue cards to assist providers in conducting the Brief Interview for Mental Status (BIMS) in Writing, the Resident Mood Interview (PHQ-2 to 9), the Pain Assessment Interview, and the Interview for Daily and Activity Preferences, as referenced in the MDS 3.0 RAI v1.18.11 coding guidance. This resource is intended to be utilized as a supplemental resident communication tool that provides a visual reference of response options. More detailed instructions regarding the use of cue cards and the administration of the BIMS in writing can be found in the MDS 3.0 RAI v1.18.11 Manual.

The cue cards are available in the Downloads section of the SNF QRP Training pages.

If you have questions about accessing the resources or feedback regarding the trainings, please email the PAC Training Mailbox. If you would like to receive email notifications related to future training resources or events, please register to be added to our Notification List. Content-related questions should be submitted to the SNF QRP Help Desk.