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New York SNFs Stretched Thin Under State Staffing Mandate

Analysis  |  By Jasmyne Ray  
   August 02, 2023

While the Biden administration has proposed a federal staffing mandate, New York state implemented theirs last year.

Staffing mandates have been touted as the answer to concerns about the quality of care provided in the nation's nursing homes. However, many facilities are unable to recruit sufficient staff to comply with the mandate.

While a federal staffing mandate has yet to be decided, some states have implemented staffing mandates of their own.

On January 1, 2022, the state of New York's staffing mandate went into effect requiring the following: a minimum daily average of 3.5 hours of nurse and certified nurse aide (CNA) care per resident per day (HPRD); a minimum of 2.2 HPRD provided by CNAs; and a minimum of 1.1 HPRD provided by a licensed practical nurse (LPN) or RN. The remaining 0.2 HPRD can be provided by an RN, LPN, or CNA.

"Member facilities have been struggling to hire staff prior to the pandemic because of New York state's low Medicaid rate," Jim Clyne, president of the New York chapter of LeadingAge, a community of nonprofit, mission-driven aging service providers, told HealthLeaders.

Until 2023, members have seen the Medicaid rate increase by only 1%, and that Medicaid pays for more than 72% of the days care is provided, he said.

Because of its low rates and Medicaid being such a large payer, which affect facilities’ ability to recruit and retain staff, member facilities are having to lower their occupancy. According to Clyne, there are currently 6,000 more unstaffed nursing home beds in New York than in 2019.

For the first quarter of 2022, Gov. Kathy Hochul waived penalties for facilities unable to maintain the necessary number of staff due to the workforce shortage, declaring it a healthcare staffing emergency. In April, with the declaration still in place, penalties began going into effect.

While the Department of Health has not released details on how penalties are assessed, they can be as much as $2,000 a day.

Staffing mandates have been criticized for their "one-size-fits-all" approach, and Clyne maintains that all nursing homes are not the same; that they have different staffing needs.

"A nursing home serving medically fragile children needs staffing that is completely different than one serving a geriatric population," he said. "Even with the geriatric population, ventilator-dependent residents are very different from dementia residents.

"Certainly, if the national mandate used additional staffing titles beyond the three nursing titles used in New York, there would be a greater recognition of the full range of services being provided to residents."

“Member facilities have been struggling to hire staff prior to the pandemic because of New York state's low Medicaid rate.”

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 


New York's staffing mandate went into effect in January 2022.

Despite a healthcare staffing emergency declaration from the governor, penalties were implemented in April after being waived for the first quarter of the year.

Facilities are struggling to hire and retain staff due to low Medicaid rates which, until 2023, have increased only 1%.

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