Long-term care patients are being neglected. Left without food, baths, and regular nursing care, patients in nursing homes and rehabilitation facilities throughout the country are suffering. In Connecticut, the problem is no better.
Nancy Sorge, whose mother resided at a nursing home in Shelton, described infections her mother developed because her facility didn’t have enough staff to change her. In three months, she lost 63 pounds after being left largely alone and unfed. In July, while aspirating on her own vomit, she passed away alone in her room.
This heartbreaking story is a reflection of the widespread problem of understaffing in long-term care facilities. Sorge explained that on her mom’s floor, there was one nurse and one nurse aid spread across the 33 patients. This level of care is unacceptable.
Over the past 18 months, Connecticut nursing homes have seen an increase in serious violations, resulting in several deaths. In a Windsor facility, a resident suffering from a swallowing disorder and dementia died after she was left unattended while eating. In a Bloomfield facility, one patient told a nurse that, “if [he] was given poison, [he] would take it.” This man, who was supposed to be monitored following multiple suicide attempts, was left alone and tragically took his own life by drinking bleach from a bottle at a nursing station. Understaffing issues are to blame for these horrifying incidents.
On Sept. 1, the Centers for Medicare and Medicaid Services (CMS) came out with a proposed rule that aims to enforce new requirements for nursing facilities. The rule includes proposals to require all facilities to have a registered nurse (RN) on staff 24/7, an update from standing federal requirements of one nurse on duty at least 8 hours per day. Additionally, the rule proposes a minimum of 0.55 registered nurse and 2.45 nurse aid (NA) hours per resident every day, for a total of three hours of individual patient care daily.
Beyond staffing requirements, the proposal aims to increase nursing home accountability through reporting requirements for Medicaid payments and strengthening staffing assessment and enforcement strategies. Lastly, the proposal attempts to grow the nursing workforce through the provision of $75 million to train NAs.
According to CMS, in Connecticut, just 16 percent of nursing facilities currently meet the proposed rule’s daily required hours per resident. To meet staffing requirements, CMS estimates that Connecticut needs 122 additional RNs and 1,136 additional NAs, increases of 5.7 and 16.9 percent respectively.
After seeing the impacts of the staffing crisis in nursing homes first hand during an internship, I, like many, am an advocate for increased staffing levels, and for good reason. Interning for a public relations firm that represents a group of long-term care facilities, I visited multiple facilities covering positive news stories. During those visits, however, I was struck by the visible effects of a staffing crisis. Far from the level of care you would hope for a loved one to receive, despite their best efforts nurses were clearly stretched thin.
Appropriate levels of provider care ensure safe, timely, and effective patient-centered care. Proper staffing ratios are known to improve patient satisfaction, but more importantly, they serve as a major indicator of patient outcomes. They prevent falls, reduce medical errors, infections, readmissions, and duration of stay. In the case of Ms. Sorge, among many others, appropriate nurse-patient ratios can be a matter of life or death.
But while CMS proposes investing $75 million in scholarships and tuition reimbursements for nurses, it does not offer financial support for long-term care facilities to attract employees with better wages or benefits. Long-term care workers are notoriously underpaid. In the wake of the COVID-19 pandemic, growing numbers of nursing staff have left the field, citing immense burnout. Attracting and retaining nursing staff through appropriate compensation is a promising way to improve patient-staff ratios, but without federal aid, it is unrealistic for most facilities.
So while the Biden Administration’s proposal includes valuable improvements, I fear that these new requirements are unrealistic. In an effort to improve care across the board, these requirements force long term care facilities to meet a one-size-fits-all set of rules. These rigid standards ignore the reality that some nursing homes have large populations of higher-need patients while others have few patients that require extensive around-the-clock care. These facilities have different staffing needs. This discrepancy, coupled with the situation that the nursing home labor market demand and available workforce are not compatible, make CMS requirements simultaneously unattainable and not strict enough.
In Connecticut, lawmakers have already tried to amend the rules. In 2021, Connecticut enacted a new law that raised minimum staffing standards from from 1.9 to 3 hours of direct patient care each day. Most recently, in 2023, the senate proposed increasing ratios to 4.1 hours a day by 2026, but the bill failed to pass in the most recent legislative session.
As requirements of the 2021 law take effect, industry leaders have argued that not being able to “mix and match” types of nursing care has been difficult for facilities, and some administrators have argued that Connecticut hasn’t properly funded Medicaid reimbursement for facilities and must do so. The 2021 Connecticut bill offers similar guidance to CMS’s proposed rule, and its existing problems will be further strained by the federal rule’s implementation.
CMS’s proposal must be seen as a step in the right direction, but it would be a mistake to accept it as is, without demanding federal aid for appropriate nursing wages and benefits. However, it would also be a mistake not to view the proposal as a valuable step in addressing the nursing home staffing crisis.
Safe staffing saves lives. As supporters, family, friends, and residents of long-term care facilities, we must raise the alarm on minimum staffing standards and support policies that promote better care and better work conditions.
Giulietta Nitido is a senior at Trinity College, majoring in Public Policy and Law.