top of page


BACKGROUND - On September 6, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a Notice of Proposed Rule Making (NPRM) that would implement a minimum staffing standard. This standard is LESS than they recommended twenty years ago as necessary to prevent compromised care even though residents in facilities today are, on average, older and require more care since they are waiting longer to enter long term care facilities.

CMS is accepting comments on this proposed rule until November 6, 2023. National Consumer Voice has developed a video tutorial to show you how quick and easy it is to submit comments. You may also find step-by-step instructions and suggestions for talking points on their website. Click the blue links above to access the video, instructions, and talking points.

We have touched on a few of these issues already in another post in this group but what I want to say to you now is that the industry's argument about the proposed rule being unfunded and unreasonable and unattainable is illogical.

  • the proposed rule only requires a staffing standard of 3.0 hours of care on AVERAGE per resident. That's .55 registered nurse hours and 2.45 CNA hours. BUT facilities have THREE YEARS to comply in urban areas and FIVE YEARS to comply in rural areas from the date of the final publication of the rule.

  • facilities must have a nurse on staff 24/7. Currently they are only required to have one eight hours per day. BUT BUT facilities have TWO YEARS to comply in urban areas and THREE YEARS to comply in rural areas from the date of the final publication of the rule

  • there are one-year waivers with no limit on the number of times facilities can apply for and obtain those waivers. They are available into perpetuity.

  • qualifications to receive waivers are based on location, good faith efforts to hire, and demonstrating financial commitment (something about documenting resources allocated to nursing). So, as you can see, facilities who CANNOT comply will not be shuttered and residents will NOT be denied care. Instead, facilities who choose to not invest in their staff have a means of manipulating the system and allowing patient care to suffer.

Please read the National Consumer Voice talking points before thoughtfully making your own. Here are my comments:

  • we need a staffing standard - even though 3.0 is not enough, please don't take it away simply because the industry is balking. IN FACT, consider increeasing it to 4.2, the average CMS said was needed 20 years ago to make sure care is not compromised

  • the 24/7 nurse requirement is excellent, needed, and there should be no waivers allowed for this requirement given the age and needs of the average resident in nursing homes today

  • there should be no waivers to facilities that cannot provide a level of care that ensures resident safety

  • during periods when facilities cannot meet minimum staffing standards, they should be limiting admissions

  • implementation timeframes should be reduced and there should be no disparity between rural and urban facilities since CMS's own staffing study in 2023 said there was almost no difference in staffing levels between rural and urban facilities

We are Texas Caregivers for Compromise and we are #notgoingaway!

10 views0 comments

Recent Posts

See All


bottom of page