April 16, 2024

At Hearing, Warren Calls on CMS to Finalize Proposed Nursing Home Minimum Staffing Rule to Ensure Safe, High-Quality Care

Witness Confirms “Virtuous Cycle” of Higher Staffing, Improved Quality of Care; Criticizes Industry Attacks on Rule

“The federal government plays a critical role in ensuring high-quality care at long-term care facilities – and that starts with the workforce. It starts with the dedicated doctors, the nurses, the nurses assistants, that provide the daily care for millions of residents.” 

“CMS should move quickly to finalize this proposed rule – and should make it even stronger. This would help improve the quality of care for residents at the same time that it's improving conditions for the staff who provide this long-term care.” 

Video of Exchange (Senate Special Committee on Aging Website, 01:17:44)

Washington, D.C. – At a hearing of the Senate Special Committee on Aging, U.S. Senator Elizabeth Warren (D-Mass.) highlighted the impact of low staffing levels on quality of care in nursing homes. As of the time of this hearing, the Centers for Medicare and Medicaid Services (CMS) is finalizing a rule that would require every nursing home to have a sufficient number of staff on hand to protect and care for residents.  

Responding to questions from Senator Warren about the importance of the minimum staffing rule,  Dr. Jasmine Travers, Assistant Professor at the New York University Rory Meyers College of Nursing, confirmed that the proposal would improve quality of care in long-term care facilities and described industry arguments opposing the proposed rule as “not valid.” Dr. Travers also affirmed that implementing new staffing standards would help with recruitment and retention of direct care workers. 

Senator Warren called on CMS to strengthen and finalize the proposed rule as quickly as possible. 

Transcript: The Long-Term Care Workforce: Addressing Shortages and Improving the Profession
U.S. Senate Special Committee on Aging
April 16, 2024

Senator Elizabeth Warren: Thank you, Chairman Casey and thank you for holding this hearing, and continuing to shine a spotlight on the long-term care workforce. The federal government plays a critical role in ensuring high quality care at long-term care facilities – and that starts with the workforce. It starts with the dedicated doctors, the nurses, the nurses assistants, that provide the daily care for millions of residents. 

Dr. Travers, one area of where you focus your research on is the quality of care in nursing homes. It's good timing that we have you here today because the Centers for Medicare and Medicaid Services is in the midst of deliberations of a proposed rule that would require every nursing home to have a sufficient number of staff on hand to protect and care for residents. Dr. Travers, can you tell me why this rule is so important? And what impact would setting minimum staffing standards at nursing facilities have on resident care?

Dr. Jasmine Travers, Assistant Professor at the New York University Rory Meyers College of Nursing: Thank you for that question. Senator Warren. So currently, as far as staffing goes in nursing homes, there's a dire shortage as you know and without sufficient staff when thinking about the standards that are currently being proposed – that's including registered nurses 24 hours a day, a resident if they're at night in inside this nursing home, and there's no RN on site, and they need medication such as a steroid medication that only a Registered Nurse can administer, then that means that they might go without that medication for that night. And unless that resident themselves – or if they have a family member who will advocate for a registered nurse to be called in – they will indeed go without that medication, and then could experience severe quality and health outcomes from that.

Senator Warren: So I'm understanding you to say that minimum staffing levels are really about the quality of care – whether or not people for example, can get the medications that their physicians have prescribed for them. Is that about right? 

Dr. Travers: That's correct. 

Senator Warren: Okay. So the nursing home industry, however, has fiercely opposed this proposal, claiming that the nursing workforce is not big enough and that nursing homes could never find the staff they need to meet these requirements. Dr. Travers, you're a long-term care workforce expert. Do you think the nursing home industry argument is valid? 

Dr. Travers: Several nursing homes have had to close during the pandemic because of staffing shortages, but the argument that [the] nursing home industry is making is not valid in that we don't need staff. 

I do believe that nursing homes believe that we do need staff. It's just that there's no support to be able to provide that staff and that's where this new bill that just was introduced today comes in as far as being able to support that staff as well and Miss Vogleman talked before about not making blanket mandates without the additional support. So most definitely, the staff are needed. I don't think anyone would or should say that staff are not needed. And just because we can't fill those roles doesn't mean that it doesn't need to happen. 

Senator Warren: Okay, so we need the staff to provide the care and I think part of what you're saying is we need resources to have the staff – which is another way of saying we need to pay them so that they will be there. 

Dr. Travers: Correct

Senator Warren: The industry is missing a key element. What we've heard from nursing home staff is that low staffing is a barrier to recruitment and retention. Nobody wants to be recruited in, nobody wants to stay, if the staffing is so low that it's putting enormous pressure on the staff who are there. 

You know, when staff are overworked, they burn out or they leave for better options. Dr. Travers, it sounds like there could be a virtuous cycle here that putting new staffing standards in place would make long-term care jobs safer, better, more attractive, and that that would help with recruiting and retention at nursing homes. Does that sound about right to you? 

Dr. Travers: That does sound absolutely right. Thank you. 

Senator Warren: Good. Well, thank you. Dr. Travers. Thank you, Senator Casey, for the bill you've introduced on this so we can put more resources in. Also the CMS should move quickly to finalize this proposed rule and should make it even stronger. This would help improve the quality of care for residents at the same time that it's improving conditions for the staff who provide this long-term care. Thank you. 

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