How to Improve Healthcare Quality Amid CMS Staffing Guidelines
As Medicare- and Medicaid-certified long-term healthcare facilities, including nursing homes and skilled nursing facilities, contend with the new CMS minimum nurse staffing standards, many industry leaders consider the mandate a one-size-fits-all approach that has the potential to do more harm than good across the healthcare continuum.
A recent analysis by the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) estimates the minimum staffing standards will require 102,000 additional nurses and aides at a yearly cost of $6.5 billion. Already facing caregiver shortages, nursing homes may have to limit admissions or close, which could displace up to 290,000 seniors.
Furthermore, the AHCA and NCAL claim that nursing homes have faced chronic Medicaid underfunding and unfunded government mandates for far too long. As a result, many facilities struggle to afford necessary enhancements in care delivery, workforce, and infrastructure.
The Ripple Effect of CMS Staffing Guidelines on Hospitals
Critics of the CMS staffing guidelines, including the American Hospital Association (AHA), argue that these rigid standards could stifle innovation in care delivery and force nursing homes, including facilities that perform well on quality and staffing metrics, to reduce capacity or even close.
Hospitals nationwide are already struggling with finding appropriate post-acute care placements for patients. The combination of clinical workforce shortages, rising complexity in patient needs, and the national mental health crisis has significantly extended hospital stays, leaving patients ready for discharge stranded in hospital beds, according to ATI Advisory.
For example, the Massachusetts Health and Hospital Association published a throughput survey in November 2023 that found 750 patients across 42 hospitals state-wide awaited discharge. In some cases, patients requiring specialized post-acute care were waiting weeks or even months to find an appropriate bed or service.
These prolonged stays strain hospital resources, compromise patient outcomes, and inflate healthcare costs.
The Complexity of Nurse-to-Patient Ratios
Countless studies have shown that appropriate nurse staffing improves patient outcomes and increases nurse job satisfaction. However, because academic research often focuses on specific facets of a subject, it's difficult to draw broad generalizations about the cause-and-effect relationships for safe staffing ratios.
In its letters to Members of Congress, the American Hospital Association emphasized that safely staffing a healthcare facility involves far more than meeting a regulatory number. It requires clinical judgment and flexibility to consider patient needs, facility-specific factors, and care team expertise.
And they’re right; nurse staffing is a complex process that changes shift by shift, so imposing minimum staffing requirements for long-term care facilities doesn't necessarily address the root of the problem. For example, it jeopardizes access to care in rural and underserved communities that may not have the workforce levels to support the requirements.
The Patient Safety Network article Nursing and Patient Safety highlights several factors that influence nurse staffing, including patient acuity, admission rates, transfers, discharges, skill mix, experience, the physical layout of nursing units, and the availability of technology and other resources.
When you factor in the complexities of nurse staffing, workforce shortages, lack of funding, hospital discharge challenges, and a growing aging population, setting minimum staffing guidelines for long-term care facilities addresses a small part of a larger issue affecting our nation's healthcare system. So, while these staffing guidelines might help in some circumstances, the healthcare industry must address the broader, more complex problems for real improvement.
5 Strategies for Complying With CMS Regulations
The Social Security Act requires any nursing home that doesn't achieve substantial compliance with the Federal Requirements within six months to be terminated from participation in Medicare and/or Medicaid.
To meet the new CMS staffing guidelines, long-term care facilities must optimize staff allocation, invest in workforce development, leverage technology for more efficient care delivery, and foster collaboration between HR and clinical teams to maintain compliance without sacrificing patient outcomes.
How can your nursing home comply with CMS regulations amid financial instability and staffing challenges? Your team must look at sustainable strategies for optimizing existing resources and joining forces with the right workforce solutions partner to ensure continuous quality care.
Here are five strategies to consider:
1. Hire More Qualified Nursing Staff
While a worker shortage may seem like the perfect time to retain staff, the reality is more complex. Studies show that the nursing shortage is driven by deeper issues beyond the pandemic, such as chronic understaffing, lack of support, emotional strain, and the pursuit of better pay.
In fact, the American Nurses Foundation's 2023 annual assessment revealed that 58% of nurses prioritize work-life balance as the most critical factor in their job satisfaction. As nurses increasingly seek flexibility, nursing homes that embrace flexible scheduling can attract top talent and stand out as preferred employers.
By offering nurses more control over their schedules, long-term care facilities can tap into the pool of nurses who left the profession due to rigid scheduling. Solutions like ShiftMed Flex and ShiftMed On Demand provide cost-effective ways to implement flexible staffing models, making meeting the needs of nurses and patients easier.
>> Tip: Perform resident assessments, considering their physical, mental, and emotional health and level of independence. Classify residents by acuity level, identifying those who require the most care, as this will directly influence staffing decisions and resource allocation.
2. Leverage Workforce Management Platforms
On-demand workforce platforms like ShiftMed On Demand and ShiftMed Unlimited Network provide direct access to local, credentialed W-2 nurses and allied healthcare professionals ready to fill your scheduling gaps. These platforms implement scheduling software to optimize staffing, ensure adequate coverage, and avoid over- or understaffing situations.
>> Tip: Conduct a shift analysis to assess how staff are scheduled across the day and week, paying particular attention to peak periods to identify gaps and address them accordingly.
3. Focus on Nursing Staff Retention
Nurses have various needs: Some may prioritize flexible scheduling, while others focus on financial incentives or opportunities for career development. Therefore, it's essential to learn what motivates them and offer incentives beyond salary.
Address staff well-being by improving work environments, offering flexible scheduling, and reducing burnout through proper workload management. After all, research shows that healthcare workers want more than a paycheck—they value rewards and benefits that fit their personal needs and life circumstances.
>> Tip: Survey your nursing staff about their workload, job satisfaction, and challenges to assess staffing adequacy and identify areas for improvement. Additionally, gather input from residents and their families regarding care quality and perceived gaps to determine where additional staffing may be needed.
4. Optimize Nursing Staffing Ratios With Technology
Workforce management solutions like ShiftMed streamline administrative tasks, allowing nurses to dedicate more time to direct patient care. These solutions leverage data analytics and advanced staffing tools to accurately forecast patient care needs and maintain compliance with staffing ratios. By predicting staffing costs based on patient requirements and necessary nursing hours, ShiftMed helps facilities optimize their workforce while enhancing the quality of care.
>> Tip: Evaluate how tasks and responsibilities are distributed among your nursing staff to spot any imbalances or inefficiencies and identify areas for improvement. Conduct time and motion studies to observe how staff spends their time, pinpointing tasks that take longer than expected or processes you can streamline for greater efficiency.
5. Identify Long-Term Care Funding Opportunities
Research and identify government and private funding programs that support staffing improvements in long-term care facilities. These programs may include grants, subsidies, or other financial incentives to enhance workforce capacity.
Consider collaborating with other healthcare organizations, industry associations, and advocacy groups to strengthen the case for increased funding and reimbursement rates. A united front can amplify voices and raise awareness about the critical need for adequate staffing in long-term care settings.
Conclusion
Navigating the complexities of CMS staffing guidelines amidst financial constraints and workforce challenges is no small feat for long-term care facilities. While the new minimum staffing standards aim to enhance patient care, they also highlight the need for a more nuanced approach that considers the diverse factors affecting healthcare delivery.
By implementing sustainable strategies—such as optimizing staff allocation, assessing patient acuity, analyzing workforce efficiency, improving staff engagement, and monitoring workforce metrics—nursing homes can better meet CMS requirements while improving healthcare quality for their residents.
But that's not to say policymakers should sit back and relax. Strengthening our nation's healthcare workforce requires investment and innovation, not inflexible mandates, as stated in an AHA letter addressed to the Honorable James Lankford of the United States Senate.