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NEW YORK (AP) \u2014 The federal government will, for the first time, dictate staffing levels at nursing homes, the Biden administration said Friday, responding to systemic problems bared by\u00a0mass COVID-19 deaths<\/a>.<\/p>\n

While such regulation has been sought for decades by allies of older adults and those with disabilities, the proposed threshold is far lower than many advocates had hoped. It also immediately drew ire from the nursing home industry, which said it amounted to a mandate that couldn\u2019t be met.<\/p>\n

With criticism expected, a promise made with fanfare in\u00a0President Joe Biden\u2019s 2022 State of the Union\u00a0speech had its details revealed as many Americans turned away from the news for a holiday weekend.<\/p>\n

\u201cEstablishing minimum staffing standards for nursing homes will improve resident safety,\u201d Health Secretary Xavier Becerra said in a statement. \u201cWhen facilities are understaffed, residents suffer.\u201d<\/p>\n

The American Health Care Association, which lobbies for care facilities, called the proposal \u201cunfathomable,\u201d saying it will worsen existing problems and cost homes billions of dollars.<\/p>\n

\u201cWe hope to convince the administration to never finalize this rule as it is unfounded, unfunded, and unrealistic,\u201d said AHCA\u2019s president, Mark Parkinson, the former Democratic governor of Kansas.<\/p>\n

READ MORE:<\/strong> Biden administration creates tougher penalties for failing nursing homes<\/a><\/p>\n

The proposed rules, which now enter a public comment period and would take years more to fully take effect, call for staffing equivalent to 3 hours per resident per day, just over half an hour of it coming from registered nurses. The rules also call for facilities to have an RN on staff 24 hours a day, every day.<\/p>\n

The average U.S. nursing home already has overall caregiver staffing of about 3.6 hours per resident per day, according to government reports, including RN staffing just above the half-hour mark.<\/p>\n

Still, the government insists a majority of the country\u2019s roughly 15,000 nursing homes, which house some 1.2 million people, would have to add staff under the proposed rules.<\/p>\n

Chiquita Brooks-LaSure, who heads the Centers for Medicare and Medicaid Services, or CMS, called the move \u201can important first step.\u201d CMS oversees nursing homes.<\/p>\n

A senior White House official, speaking on the condition of anonymity ahead of the announcement, said the Biden administration was open to revisiting the staffing threshold once implemented.<\/p>\n

\u201cI would caution anyone who thinks that the status quo \u2013 in which there is no federal floor for nursing home staffing \u2013 is preferable to the standards we\u2019re proposing,\u201d said Stacy Sanders, an aide to Becerra. \u201cThis standard would raise staffing levels for more than 75% of nursing homes, bringing more nurse aides to the bedside and ensuring every nursing home has a registered nurse on site 24\/7.\u201d<\/p>\n

The new thresholds are drastically lower than those that had long been eyed by advocates after a\u00a0landmark 2001 CMS-funded study<\/a>\u00a0recommended an average of 4.1 hours of nursing care per resident daily.<\/p>\n

WATCH:<\/strong> New York hospitals, nursing homes offer vaccine incentives and brace for staff shortages<\/a><\/p>\n

Most U.S. facilities don\u2019t meet that threshold. Many advocates said even it was insufficient, not taking into account quality of life, simply determining the point at which residents could suffer potential harm.<\/p>\n

After the Democratic president elevated the issue in his State of the Union speech, advocates were initially elated, expecting the most significant change for residents since the Nursing Home Reform Act of 1987. That changed after a copy of a new CMS-funded study on the subject\u00a0was inadvertently posted this week<\/a>, claiming there is \u201cno obvious plateau at which quality and safety are maximized.\u201d<\/p>\n

Advocates were bereft, saying they felt betrayed by administration officials they thought to be allies. As word of the proposal became public early Friday some were even more blistering.<\/p>\n

Richard Mollot, who leads the Long Term Care Community Coalition, called it \u201ccompletely inadequate\u201d and a blown chance of \u201ca once-in-a-generation opportunity\u201d that \u201cflouts any evidence\u201d of what residents need and fails to make good on the heart of Biden\u2019s promise. He begrudgingly acknowledged the 24\/7 RN rule could bring small improvements to the worst facilities, but he otherwise was withering in his criticism.<\/p>\n

Calling the move \u201cheartbreaking\u201d and \u201cnauseating,\u201d he said it would do more harm than good, putting a government imprimatur on poorly staffed homes and imperiling wrongful-death lawsuits.<\/p>\n

\u201cIt is a tremendous dereliction of duty,\u201d he said. \u201cWe are continuing to allow nursing homes to warehouse people and to rip the public off.\u201d<\/p>\n

Current law\u00a0requires only that homes have \u201csufficient\u201d staffing<\/a>, but it leaves nearly all interpretation to states. Thirty-eight states and the District of Columbia have their own staffing regulations. Some are so low that advocates say they\u2019re meaningless, and, across the board, enforcement is often toothless.<\/p>\n

The problem has long been apparent to front-line nurse aides \u2013 the low-paid, overwhelmingly female and disproportionately minority backbone of facility staffs \u2013\u00a0and to residents themselves, whose call bells go unanswered, whose showers become less frequent and who lie hungry, awaiting help with meals.<\/p>\n

The coronavirus pandemic, which claimed more than 167,000 U.S. nursing home residents, brought the greatest attention to poor staffing in history. But, in its wake, many homes\u00a0saw their staffing grow even thinner.<\/p>\n

Across all job types, Bureau of Labor Statistics data shows nursing homes have 218,200 fewer employees than in February 2020, when the first U.S. outbreak of the coronavirus arrived at a nursing home outside Seattle.<\/p>\n

AHCA has waged a relentless campaign claiming facilities were teetering, with Medicaid subsidies insufficient, widespread hiring issues and rampant home closures. But there has been no sign of widespread closures, the profitability of homes has repeatedly been exposed and critics have argued, if they just paid better, the workers would come.<\/p>\n

Katie Smith Sloan, the head LeadingAge, which represents nonprofit nursing homes, said it was meaningless to create a rule requiring facilities to hire additional staff when the industry was already in a workforce crisis and \u201cthere are simply no people to hire.\u201d<\/p>\n

\u201cTo say that we are disappointed that President Biden chose to move forward with the proposed staffing ratios despite clear evidence against them is an understatement,\u201d she said.<\/p>\n<\/p><\/div>\n

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