The battle over nursing home rules


The first phase of the Biden administration’s nursing home staffing mandate is about to take effect.

The Biden administration is moving full steam ahead on its contentious nursing home staffing mandate, even as it battles legal challenges in court.

The rule, finalized in April, is a game changer for facilities that provide skilled nursing and assistance to people who can’t live independently but don’t need to be in a hospital. It mandates a registered nurse be on-site 24/7 and requires staff to provide residents with at least 3.48 hours of direct care a day, such as feeding, bathing or administering medication.

Much of the final rule is set to be phased in during the next few years, but the policy also beefs up requirements for the self-assessments each nursing home must perform annually to determine whether they have enough skilled workers to properly care for their residents. The Centers for Medicare and Medicaid Services gave operators 90 days to complete the updated facility assessment, and the deadline is Thursday.

CMS has issued guidance to help nursing homes with the updated review, but operators find some requirements vague, making it difficult to complete the assessment properly.

For example, the agency says that operators must update their facility assessment when there is a “substantial modification,” but it doesn’t define what that term means, said DeeAndra Sandgren, the chief nursing officer at Good Samaritan Society, which operates a large chain of nonprofit nursing homes.

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