CMS Staffing Mandate for Nursing Homes Explained

05.24.2024 /

Nursing Home CMS Staffing Mandate: What is it and how can operators prepare?

By Andrew Boland – Director of National Healthcare Financing, Popular Bank

A minimum staffing standard for nursing homes across the country was unveiled last month, raising concerns from operators and industry leaders over the impact the mandate will have on their ability to maintain adequate access to long-term care.

Nearly all nursing homes (14,340 out of about 14,500 facilities that receive federal funding) are understaffed according to the new mandate. The discrepancy particularly affects facilities located in rural areas and Southern States.

The Centers for Medicare & Medicaid Services (CMS) staffing mandate calls for 3.48 hours of daily care for each resident, allocated between registered nurses, nurse aides and other nurse staff.

Depending on location, nursing homes will have between three and five years to staff up to remain compliant. 

According to a recent USA Today survey, nearly half of all nursing home facilities can meet the RN care mandate (0.55 hours of care per resident per day), however recruiting nurse aides and other nursing staff may become a priority for many.


5 ways to prepare.

Developing a staffing plan of action for the next few years can ease the stress of navigating the new requirements. Staying informed, making sure your facility’s current procedures align with the CMS mandate, investing in staff training, resident engagement and community partnerships can all aide in finding the right solution for your facility.

1. Stay informed.

Nursing home operators can stay abreast of developments related to the CMS mandate by monitoring legislative updates, participating in industry forums, and engaging with regulatory agencies and advocacy groups.

It is also important to anticipate stricter guidelines for quality of care, including measures to prevent neglect, abuse, and exploitation. Focus on implementing quality improvement initiatives, such as regular audits, staff training programs, and resident feedback mechanisms to align with the new regulation.

2. Develop “outside of the box” staff training.

Prioritize staff training and education programs to ensure that employees are equipped with the knowledge and skills necessary to meet the proposed standards of the new mandate. Areas of focus could include resident rights, infection control, dementia care, and communication skills.

Nursing home operators could also consider coordinating or working with local trade schools or universities for staff development. Developing a local talent pipeline will help meet the staffing mandate as well as bring jobs into the community.

3. Stakeholder collaboration.

Build partnerships with community organizations, healthcare providers, and regulatory agencies to enhance collaboration and resource sharing. Participate in collaborative initiatives aimed at improving elder care standards and advocating for policy reforms. These discussions will lend a platform to share key insights and challenges that others may not be aware of such as transportation for workers, non-existent employee or candidate pool. Taking the opportunity to speak with local government officials to voice concerns or share best practices.

4. Modernize reporting procedures.

Assess current practices, policies, and procedures to identify areas that may require adjustment to align with the new mandate. Prepare your facility to operate in a higher transparency environment, ready to report on staffing levels, inspections and complaint resolutions. Streamline reporting processes and ensure accurate documentation to minimize the stress of audit procedures and mitigate regulatory risks.

5. Enhance resident engagement.

Foster a culture of resident-centered care by actively involving residents and their families in decision-making processes, care planning, and quality improvement initiatives. Solicit feedback and address concerns promptly to promote resident satisfaction and well-being.


Enlist a knowledgeable banking partner.

Complying with the mandate seems daunting as well as costly. The ability to hire tens of thousands to support staffing requirements in the healthcare industry presents a real challenge, especially in rural parts of the country. Some nursing home providers are investing in their own infrastructure and programming to train and develop staff.

Enlisting the right banking partner – with specific industry knowledge and track record – will help you develop a plan to remain prepared for escalating costs and margin compression. A banking partner with a dedicated healthcare financing team can take a holistic look at your financial circumstances, determine the appropriate products for working capital, acquisition or refinancing needs.

The new mandate is likely to significantly impact nursing home operations, requiring operators to adapt to stricter regulations and higher standards of care. With the right team by their side, nursing home operators can strengthen their operations, ensure compliance, uphold quality standards, and prioritize the well-being of elderly residents. Through strategic planning, staff training, and collaboration with stakeholders, nursing homes can navigate the changing landscape and continue to provide high-quality care to seniors in their communities.


Andrew Boland
Director of National Healthcare Financing
Popular Bank

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