Bohler Forrest, Adashi Eli Y
Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI, 48309, USA.
Brown University, 222 Richmond St., Providence, RI, 02903, USA.
J Gen Intern Med. 2025 Jul;40(9):2126-2127. doi: 10.1007/s11606-025-09360-6. Epub 2025 Jan 14.
On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) announced new staffing mandates for long-term care (LTC) facilities in an effort to improve care quality in nursing homes (NHs). The guidelines require a minimum of 3.48 h of daily care per resident, including 0.55 h provided by registered nurses (RNs), 2.45 h by nurse aides (NAs), and an additional 0.48 h by other care staff. These requirements, including a 24/7 RN presence, aim to address chronic understaffing that has been linked to poor outcomes such as increased emergency visits and lower compliance with quality standards. However, concerns from for-profit NHs and the American Healthcare Association (AHCA) suggest that many facilities are ill-prepared to meet these standards, citing financial and staffing challenges, particularly in rural areas. In addition, a lawsuit from Texas Attorney General Warren Paxton argues that CMS overstepped its regulatory authority. Despite these challenges, workforce shortages may be alleviated by the CMS initiatives, which include a $75 million national campaign to grow the NH workforce. This commentary discusses the implications of the CMS staffing rule, the legal challenges it faces, and the potential to improve RN work conditions and resident care. The paper concludes with recommendations for expanding workforce capacity and enhancing compliance through financial investment and policy reform.
2024年4月22日，医疗保险和医疗补助服务中心（CMS）宣布了针对长期护理（LTC）机构的新人员配备要求，以提高养老院（NHs）的护理质量。这些指导方针要求每位居民每天至少接受3.48小时的护理，其中包括注册护士（RNs）提供的0.55小时、护士助理（NAs）提供的2.45小时，以及其他护理人员提供的额外0.48小时。这些要求，包括24/7有注册护士在岗，旨在解决长期存在的人员配备不足问题，而这一问题与诸如急诊就诊增加和质量标准合规性降低等不良后果有关。然而，营利性养老院和美国医疗保健协会（AHCA）的担忧表明，许多机构没有做好准备来满足这些标准，理由是存在财务和人员配备方面的挑战，尤其是在农村地区。此外，得克萨斯州总检察长沃伦·帕克斯顿提起的一项诉讼称，CMS超越了其监管权限。尽管存在这些挑战，但CMS的举措可能会缓解劳动力短缺问题，其中包括一项7500万美元的全国性活动，以增加养老院工作人员数量。本评论讨论了CMS人员配备规定的影响、它所面临的法律挑战，以及改善注册护士工作条件和居民护理的潜力。本文最后提出了通过财政投资和政策改革来扩大劳动力能力和加强合规性的建议。
