Audio: Increased staffing requirements proposal sparks controversy for Missouri nursing homes

Nurse assisting patient in wheelchair in nursing home

(Missourinet/KTTN) – The federal government has proposed a rule aiming to improve nursing home care nationwide, including in Missouri. This rule mandates a minimum daily staffing level of 2.45 hours per resident for nurse aides, 0.55 hours for registered nurses, and the presence of a registered nurse on-site 24/7.

The government asserts that these requirements will enable older Americans to age with dignity and ensure high-quality care for people with disabilities. It also aims to hold nursing homes accountable for providing safe care.

However, the Missouri Health Care Association, representing about 350 state nursing homes, opposes the proposal. Nikki Strong, the Association’s executive director, highlights the lack of additional federal funding in the proposed rule. She estimates that nearly 4,000 additional staff would be required to meet this mandate, a challenging feat given current staffing shortages.



Strong emphasizes the significant impact this rule could have on the state’s nursing homes, particularly in rural areas already struggling with staff recruitment. She foresees widespread facility closures if the rule is implemented.

According to Strong’s analysis of Medicare cost reports, the staffing rule would cost Missouri nursing homes approximately $198 million annually. She points out that Medicaid, covering nearly three-fourths of funding for these facilities in Missouri, is already underfunded, with a current average shortfall of $50 per patient per day.

Strong argues that the proposal, while well-intentioned, would create accessibility issues, force facility closures, and hinder patient care rather than improve it.

The proposed rule specifically targets Medicaid or Medicare-certified nursing homes, excluding assisted living locations, hospitals, and other healthcare settings. About 496 Missouri facilities would fall under this mandate, potentially impacting the broader healthcare system due to reduced patient admission capacity.

Fifteen Republican governors, including Missouri’s Gov. Mike Parson, have urged President Biden to reconsider this rule. They argue that the long-term care industry, especially in rural areas, is already in a workforce crisis and that the proposal imposes a rigid, one-size-fits-all approach, threatening many care facilities with closure.

The federal government is currently reviewing approximately 43,000 public responses to the proposal, which will inform their decision on whether to modify the rule.