The place are we going to get the employees to take care of us?  How are we going to pay them? 

For my part, long-term care is without doubt one of the main challenges going through an growing old society.  Care can take the type of a nursing dwelling, formal care offered in the neighborhood or dwelling, or casual care offered by household or buddies.  KFF lately launched a really nice summary of the state of play on the nursing dwelling entrance within the strategy of describing a proposed rule that may create new staffing necessities.

No one actually needs to go to a nursing dwelling, and the long-standing staffing points mixed with the demise of 170,000 residents throughout COVID have contributed to a decline between 2015 and 2023 within the variety of nursing properties and nursing dwelling residents.  This decline has occurred regardless of a major enhance in potential prospects because the inhabitants ages (see Determine 1).

Let’s begin with the best measure – the variety of nursing properties.  To be eligible for reimbursement below Medicare or Medicaid, nursing properties should be licensed by the Facilities for Medicare and Medicaid Companies (CMS).  The variety of licensed nursing amenities declined 4 p.c between 2015 and 2023 (see Determine 2).

Bar graph showing the number of nursing facilities certified by CMS, 2015 and 2023

Over the identical interval, the variety of nursing dwelling residents declined by 12 p.c, as folks more and more opted for care of their neighborhood or dwelling (see Determine 3).  The COVID deaths exacerbated the decline.

Bar graph showing the number of nursing home residents, in millions, 2015 and 2023

And the remaining residents obtained fewer hours of care.  The decline was pushed by a 21-percent drop within the care offered by registered nurses (RNs), who’re chargeable for assessing the wants of residents and delivering total care.  The hours of care offered by licensed sensible nurses (LPNs), who’re chargeable for ensuring every resident’s plan of care is carried out, truly elevated barely.  The third a part of the group consists of nurse aides, who work below the licensed nurses and help with actions of each day dwelling, corresponding to consuming, bathing, dressing, strolling, and utilizing the lavatory.  The hours offered by nurse aides, who’re the individuals who spend probably the most time with the residents, declined by 10 p.c (see Desk 1).

Table showing the total nursing hours per resident day, 2015 and 2023

Apparently, the Biden administration’s new proposed staffing rule for registered nurses of 0.55 hour per resident day is barely decrease than the common offered in 2023.  The proposed minimal of two.45 hours for nurse aides is barely increased than the common at the moment offered.  The rule consists of no proposed minimal for licensed sensible nurses.  

The typical, nonetheless, may disguise numerous variation amongst nursing amenities, and the info on the common variety of deficiencies and the share of amenities with severe deficiencies counsel that many amenities are offering considerably fewer hours than the brand new proposed minimums (see Desk 2).

Table showing the average deficiencies per nursing facility and share involving actual harm

The proposed new rule for minimal hours acknowledges the staffing drawback at nursing properties, but additionally raises the bigger questions of whether or not now we have ample employees to take care of an growing old inhabitants and the way we’re going to pay for all that care.


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