Biden-Harris Administration Takes Historic Action to Increase Access to Quality Care, and Support to Families and Care Workers

Nursing home minimum staffing standards promote resident care and safety 

Nursing Home Staffing Standards

Establishing minimum staffing standards for nursing homes is a critical step in the Biden-Harris Administration’s comprehensive approach to building a long-term care system where all older Americans can age with dignity.  Nursing home workers provide vital – although often undervalued – care for nursing home residents, assisting them with important daily tasks, such as bathing, dressing, mobility, and eating. These direct care workers, who are often women of color, typically earn low wages, rarely receive health and retirement benefits, and experience high injury rates. The Biden-Harris Administration believes that by improving working conditions and wages, improvements in the recruitment and retention of direct care workers will follow, enabling nursing staff to provide safer, higher quality care to all residents within nursing homes. 

Over 1.2 million residents receive care in Medicare- and Medicaid-certified nursing homes each day. Adequate staffing is essential to providing an environment where residents receive safe, high-quality care while being treated with dignity. CMS received and considered more than 46,000 public comments on this rule from various stakeholders, including residents and their family members, workers, advocates, and the industry. Many of these comments highlighted how –without sufficient staff – residents do not receive necessary care including baths or trips to the bathroom, and experience preventable safety events, such as pressure ulcers and falls. Because of the final rule, nursing homes participating in Medicare and Medicaid will be required to follow designated nurse staffing standards:

  • Provide residents with a minimum total of 3.48 hours of nursing care per day, which includes at least 0.55 hours of care from a registered nurse per resident per day, and 2.45 hours of care from a nurse aide per resident per day. 
  • Have a registered nurse on site 24 hours per day, seven days per week to help mitigate against preventable safety events and deliver critical care to residents at any time.  
  • Conduct a stronger annual facility assessment than is currently required to improve the planning and identification of the resources and supports that are needed to care for residents based on their acuity during both day-to-day operations and emergencies. This process will need to include participation from direct care workers and others.
  • Develop a staffing plan to maximize recruitment and retention. 

As part of the Biden-Harris Administration’s commitment to the long-term care workforce, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers and support staff delivering care in nursing facilities and intermediate care facilities for individuals with intellectual disabilities. To increase transparency and accountability, CMS will publicly report the data reported by states, and states will also be required to report this data for each facility on a state-operated website.  

The Biden-Harris Administration is committed to bolstering the health care workforce and ensuring the contributions of workers across the long-term care sector are appropriately valued. CMS is developing a $75 million national nursing home staffing campaign to increase the number of nurses in nursing homes, thereby enhancing residents’ health and safety. Through this campaign, CMS will be providing financial incentives for nurses to work in nursing homes.