Substantial Financial Investment Vital for Achieving Minimum Staffing Levels in SNFs

Targeted support of low-resource facilities and substantial financial investment in the workforce is necessary for achieving minimum nurse staffing levels proposed in 2019 US congressional bills for skilled nursing facilities (SNFs), according to authors of a study recently published in the Journal of the American Geriatrics Society.

“We estimate that achieving the proposed federal minimums across SNFs nationwide would require an estimated additional 35,804 registered nurse (RN), 3509 licensed practical nurse (LPN), and 116,929 certified nursing assistant (CNA) full-time equivalents (FTEs) at $7.25 billion annually in salary costs based on current wage rates and prepandemic resident census levels,” stated study authors.

Researchers examined characteristics of SNFs not meeting proposed minimum thresholds by conducting a cross-sectional analysis of the Hospital Wage Index, 2019 quarter 4 payroll data, and additional administrative data for 14,964 Medicare and Medicaid-certified SNFs. Proposed minimum thresholds were, “4.1 total nursing hours per resident day (HPRD), 0.75 RN HPRD, 0.54 LPN HPRD, and 2.81 CNA HPRD.”

Study authors calculated additional HPRD needed as well as associated FTE personnel, and salary costs for any SNFS that were below the thresholds. Results showed that in 2019, 25% of SNFs met the minimum total nursing HPRD, 31% met the RN threshold, 84.5% met the LPN threshold, and 10.7% met the CNA threshold.

“In adjusted analyses, factors most strongly associated with SNFs not meeting the proposed minimums were higher Medicaid census, larger bed size, for-profit ownership, higher county SNF competition, and for RNs specifically, higher community poverty and lower Medicare census,” stated study authors.

In addition, findings showed county SNF competition resulted in rural SNFs being less likely to meet all categories.

“Extensive recruitment and retention efforts are needed to overcome supply constraints, particularly in the aftermath of the COVID-19 pandemic,” concluded authors of the study.

Reference:
Hawk T, White EM, Bishnoi C, Schwartz LB, Baier RR, Gifford DR. Facility characteristics and costs associated with meeting proposed minimum staffing levels in skilled nursing facilities. J Am Geriatr Soc. Published online February 3, 2022. doi:10.1111/jgs.17678