Nursing and care facilities that receive federal funding have operated under the requirement that nurse staffing requirements be “sufficient.” What is “sufficient” has been left to state legislators, regulators, and care home administrators.
On Monday, April 22, 2024, the Biden administration announced new rules to define “sufficient” that call for staffing equal to 3.48 hours per resident per day. Slightly more than half an hour of that is to come from registered nurses.
Anne Deneen of Grand Marais, MN, addressed the North Shore Health Board of Directors meeting during its public comment section on April 18, 2024. The public meeting was held at the Schaap Community Center on the Gunflint Trail.
Deneen spoke about staff shortages and the Care Center, where her mother is a resident. On March 23, Deneen wrote an email to the NSH CEO and its board describing a staffing shortage she’d witnessed that day. She reported that there were 19 patients in the wing of the nursing home where her mother resides, and on that day, one nurse and one nurse’s aide were on duty.
Deneen’s email asked about current staffing policies and what is being done to rectify staffing shortages.
In a responsive email from NSH CEO Kimber Wraalstad dated April 18, Deneen was told, “The staffing for March 23 was 4.21 hours per resident day and for March 24 was 4.20 hour per resident day, exceeding the proposed federal staffing ratios of 3.1 hours per resident day.”
After receiving Wraalstad’s response, Deneen wrote in an email to the Northshore Journal, “I can tell you that I got an email response from Kimber Wralstad. She stated that in all previous emails, I never asked questions and that their staffing on the weekend in question was above regulated minimums.”
She added, “She (Wraalstad) skips over the fact that it GOT to minimums because direct care staff and family, me, cobbled it together.”
According to Medicare, “Staffing hours per resident per day is the total number of hours worked by each type of staff divided by the total number of residents.”
Under Minnesota statute 144A.04, Subd.7, “the “hours of nursing personnel” means the paid, on-duty, productive nursing hours of all nurses and nursing assistants, calculated on the basis of any given 24-hour period.”
The statute states, (a) The minimum number of hours of nursing personnel to be provided in a nursing home is the greater of two hours per resident per 24 hours or 0.95 hours per standardized resident day.
The statutory formula for calculating nursing hours per standardized resident day is “performed by dividing the total hours of nursing personnel for a given period by the total of standardized resident days for that same period.”
Using the state formula to provide for 19 care patients for one week would require 266 nursing hours, or 38 hours per day. Plugging in the new federal guidelines of 3.48 hours per patient per day, the same one-week period requires 463 hours, an average of 66 hours per day.
Interest groups representing nursing home providers are opposing this new rule.
A day after the administration issued the first rule, it issued another that required that 80% of the money those institutions received be used to pay workers, not administrative or overhead costs.
