New Jersey proposed changes to its new nursing home staffing regulations

The New Jersey Department of Health has proposed amendments to regulations that would help nursing homes meet new staffing ratios that took effect in early 2021.

The proposal, open to public comment through Aug. 19, would allow nursing homes to get credit toward their certified nurse aide ratio when they assign a registered nurse or a licensed practical nurse to perform the duties of an aide during evening and night shifts.

The February 2021 standards require nursing homes to have one nurse aide for every eight residents during daytime shifts. The ratio is 10 residents per direct-care staffer — possibly a registered nurse under the proposal — on the evening shift and 14 during the night shift.

The proposal would also give nursing homes a three-day grace period to meet staffing ratios when the number of patients they are caring for increases to a level that would require additional direct-care staff.

“We have seen since early 2021, when this CNA staffing ratio was implemented, that as much as nursing homes would love to comply and as hard as they try, they simply cannot because the workers are not out there,” Andy Aronson, president and CEO of the Health Care Association of New Jersey, a trade group for long-term care operators, said in an email.

Data on the health department website show that in the first quarter of this year, 134 of the state’s 362 nursing homes either failed to meet the ratio for certified nursing assistants during the day shift or had too much data missing to calculate the ratio.

At least one South Jersey nursing home was fined this year for not meeting nurse aide ratios. Investigators found that on six days in late March and early April, Sterling Manor in Maple Shade failed to have enough nurse aides, mostly during the day shift. The fine was $5,000.

The proposed regulation would eliminate fines for initial violations. Richard Mollott, executive director of the Long Term Care Community Coalition, an advocacy group in New York, said he finds that change troubling.

The grace period is also a problem, Mollott said.

“It contradicts with the longstanding federal requirement that a nursing home only accept and retain residents for whom they have sufficient staff, with the appropriate competencies, to provide the care and services necessary for each resident to attain and maintain their highest practicable physical, emotional, and psycho-social well-being,” he said.

In Pennsylvania, nursing-home staffing ratios took effect for the first time on July 1. They require one nurse aide for every 12 residents during day shifts. That ratio changes to one nurse aide per 10 residents next July.