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The Future of Long-Term Care: Navigating the Finalized Staffing Mandate


Since the Centers for Medicare & Medicaid Services (CMS) first announced plans for a staffing mandate back in April, ESI has received feedback from many concerned senior housing and skilled nursing facility owners nationwide. These owners, already struggling to fill open positions, now face the difficult task of finding additional nurses, while also affording their salaries. Two tasks that feel near impossible.


Recently, the CMS issued its Final Rule, outlining the minimum staffing standards that will take effect on June 21, 2024. The final rule can be found here: Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting


In short, here is what owners need to know about the mandate, the upcoming challenges, and how to plan to support their communities' success.


Key Highlights of the Final Ruling


  • Minimum Staffing Levels: 3.48 hours per resident day (HPRD), of which must be 0.55 registered nurse (RN) and 2.45 nurse aide HPRD. 

  • Flexibility of Staffing: Facilities may utilize a mix of nurse staff, including RNs, LPNs/LVNs, or nurse aides, to meet this standard. 

  • 24/7 RN Presence: All nursing facilities are required to have an RN on-site 24/7 by summer of 2027

  • Assessment Requirements: New reporting and assessment requirements as well as a detailed process


Challenges of Meeting The New Requirements


According to a survey by AHCA/NCAL, 96% of providers are concerned about meeting the federal staffing mandate. The main challenges we hear about include high recruitment and training expenses, shortage of qualified candidates, and increased strain on existing staff.


In rural America, the federal staffing mandate puts an even larger emphasis on the challenges listed above, specifically the smaller pool of qualified healthcare workers in the market. Although rural communities are getting extra time to meet these standards, many owners are still afraid they will not have the funds to make it happen.


Rural or urban, all skilled nursing owners are concerned with how to meet these new requirements while remaining profitable.


How to Protect Your Bottom Line while Navigating the Staffing Mandate


As June 21st approaches, we strongly encourage owners to get an unbiased, data-driven understanding of their financial performance. ESI has invested over a decade in our proprietary database of skilled nursing communities across the country. We use our robust data on operating revenue and expense metrics to benchmark our clients' performance against similar facilities locally, regionally, and nationally.


For skilled nursing owners, our benchmarking service includes an in-depth comparison of our clients Medicare census, Medicare rate, operating expenses, and staffing trends compared to their competition. We identify key areas in which our clients can improve and overall increase their financial performance.


ESI has an in-depth presentation available to watch on our webinar channel with more detail on the benefits of benchmarking skilled nursing nursing communities.



If you are interested in a benchmarking analysis of your skilled nursing facility or portfolio, there is no better time to get started. ESI provides this service to owners at no cost with no obligation to you. Contact us to get started.


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