Advocacy in Action (May 2024): Nursing Home Minimum Staffing Rule

Libby Hastings • May 15, 2024

Recently, we have been disheartened by legislative actions that undermine efforts to improve staffing standards in nursing homes, particularly in Kansas. H.R. 5796, co-sponsored by Representatives Tracey Mann, Jake LaTurner, and Ron Estes, seeks to disapprove a federal staffing standard minimum rule that would greatly benefit residents of nursing facilities. Similarly, S.3410, co-sponsored by Senators Roger Marshall and Jerry Moran, aims to address the same issue in the Senate. If passed, these legislations would prohibit the Secretary of Health and Human Services from implementing the final settings rule for minimum staffing in nursing facilities. 

 

The Nursing Home Minimum Staffing Rule finalized on April 22nd will require all nursing homes that receive federal funding through Medicare and Medicaid to have 3.48 hours per resident per day (hprd) of total staffing, including a defined number from both registered nurses (0.55 hprd) and nurse aides (2.45 hprd). It will also require facilities to have a registered nurse onsite 24 hours a day, seven days a week.

 

At the heart of this issue is the need for adequate staffing levels in nursing homes. Research consistently shows that higher staff-to-resident ratios lead to better outcomes for residents, including reduced rates of infections, fewer falls, and improved overall quality of life. By opposing the implementation of a federal staffing standard minimum rule, these legislators are failing to prioritize the well-being of vulnerable older adults in Kansas and across the nation.

 

Additionally, it's disappointing to see the nursing home industry diverting attention away from the real issue at hand. Instead of lobbying against essential staffing regulations, they should be directing their efforts towards hiring and retaining qualified staff, ensuring fair wages, and creating supportive work environments. Working in a nursing facility is a skilled job that deserves respect, and addressing the staff shortage requires dedicated time and attention.

 

However, amidst these challenges, we find hope in the actions of the Biden administration and advocacy organizations who have pushed for measures to improve staffing standards in nursing homes. We applaud their commitment to addressing this critical issue and urge them to continue their efforts.

 

In Kansas, the Medicaid program spends $95,000-$108,000 annually per resident for often sub-standard care. The state allocates approximately $862 million to long-term care facilities, yet Kansas ranks 46th in addressing the shortage of nurses and nurse aides. Taxpayers deserve greater value for their money, and older Kansans deserve improved long-term care options given the consistently poor performance of many in this industry.

 

We cannot afford to ignore this problem any longer. To effectively address the staffing shortage problem in Kansas, we must also look to other states for guidance and best practices. By learning from successful initiatives implemented elsewhere, we can tailor solutions to suit the unique needs of our state's long-term care facilities. Furthermore, it's crucial to foster a collaborative effort that includes the voices of long-term care residents and staff in these discussions. By actively involving those directly impacted by staffing challenges, we can develop more comprehensive and effective strategies to ensure quality care for all individuals in nursing homes.

 

We encourage our readers to act. Contact your Kansas Congressional delegates and share your stories about why staffing is critical to improving quality metrics across the board.

 

Your voices matter, and together, we can make a difference in the lives of countless individuals in long-term care facilities.

 


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Advocacy in Action (June 2025): One Investigator, 70 cases, APS is Stretched Too Thin

May 29, 2025
In a recent article published by The Beacon, reporter Blaise Mesa spotlights a heartbreaking case that exemplifies both the critical importance and serious strain facing Kansas Adult Protective Services (APS). The article, “One elder abuse investigator has 70 cases. Kansas doesn’t say how swamped other caseworkers are,” tells the story of Shirley Crow, an 85-year-old woman with Alzheimer’s whose family trusted a caretaker to manage her daily medications and appointments. That trust was broken. Despite filing a report with APS, Shirley’s family received few updates. Weeks after their report, Shirley passed away. Her case remains open—one of 10,000 APS investigations initiated in Kansas each year. The assigned APS caseworker? She has 70 other cases. This is not a story about blame. As Shirley’s daughter-in-law, Stacy Crow, told The Beacon , “We got an investigator that I truly believe has a heart… I understand they have an overwhelming demand… I don’t fault them. I just want things to change.” And so do we. Systemic Overload and the Urgent Need for Reform The Kansas Department for Children and Families (DCF), which oversees APS, has not publicly disclosed average caseloads. While DCF clarified post-publication that they do track this information, they choose not to release it, citing confidentiality. The lack of transparency and standardization prevents meaningful accountability and reform. National standards suggest 20–25 cases per worker is a manageable caseload. Kansas APS staff, in some cases, are handling double or triple that amount. With cases increasing year over year— 18,056 in fiscal year 2025 alone—the risk of delayed intervention or missed warning signs only grows. This Is a Wake-Up Call. At KABC, we continue to push for better protections for older adults, more robust support for APS investigators, and greater transparency and accountability from state agencies. In our recent blog post, “ What Happens When You Report to Adult Protective Services? ” we outline the crucial role APS plays in protecting vulnerable adults and how reporting suspected abuse can quite literally save lives. To report suspected abuse, neglect, or exploitation of a vulnerable adult in Kansas: For older adults living at home in the community or in facilities licensed by the Kansas Department of Aging and Disability Services when the perpetrator is not a resident of or staff of the facility, report to the following: Adult Protective Services (APS): 1-800-922-5330 If an emergency, call your local law enforcement agency or 911 Reporting initiates a multi-step process involving a prompt in-person visit, interviews, and, when needed, development of a service or prevention plan. The goal of APS is to protect, not to punish- to connect individuals to medical care, housing, legal services, or safety planning. But APS cannot fulfill that mission if it's underfunded, overwhelmed, and operating in the dark.  What Needs to Change: Transparency: Kansas must publicly release average caseload data and investigation timelines. Support for APS Workers: State leaders must prioritize hiring and retaining qualified APS staff and ensure manageable caseloads. Federal Investment: Continued and expanded federal funding for APS is essential—not optional. Public Awareness: Communities need to understand when and how to report suspected abuse, and how they can be part of the safety net. The APS system should be a lifeline, not a last resort.

5 Questions to Ask When Choosing a Long-Term Care Facility

May 21, 2025
Choosing a long-term care facility for yourself or a loved one is one of the most important decisions you can make. Beyond basic safety and cleanliness, the right facility should support a person’s independence, dignity, and overall quality of life. To help you make an informed choice, here are five essential questions to ask, along with key follow-ups that can give you a deeper sense of what daily life will be like at the facility. 1. How does the facility support independence and person-centered care? Person-centered care means that residents are active participants in their care and daily routines. Ask: Can residents choose when to wake up and go to bed? Are meals and activities tailored to individual preferences? Is there flexibility for “early birds” and “night owls”? Look for signs that staff respect residents’ individuality—such as accommodating dietary preferences and encouraging participation in meaningful activities. 2. What medical and rehabilitation services are available on-site? Quality care goes beyond assistance with daily activities. Ask about: Access to hospice care and pain management Availability of wound care and ostomy specialists In-house physical, occupational, speech, and mental health therapies Staffing levels—how many nurses and aides are on duty at different times of day? These services can have a major impact on recovery, mobility, and comfort. 3. What is the atmosphere like during meals and activities? Daily life should be engaging and social. Ask to observe a meal or an activity session. Consider: Are residents out of their rooms and interacting with others? Do meals look appetizing and meet special dietary needs? Is assistance with eating provided promptly and respectfully? Also ask about field trips, volunteer involvement, and whether there is an active activities room or calendar of events. 4. What do current residents and families say about their experience? Talking to those already living in or visiting the facility can give you valuable insight. Ask residents: Do staff respond quickly when you call for help? Do you enjoy your meals and feel your privacy is respected? Are you involved in decisions about your care? Ask families: Are you promptly notified of any accidents or health changes? Do you feel comfortable raising concerns? Is there a Family Council and does the facility listen to it? 5. How transparent and responsive is the administration? A responsive leadership team is key to resolving issues and maintaining quality. When meeting with the Administrator or Director of Nursing, ask: How do you handle complaints? How are staff trained and how long do they typically stay? What’s your policy on resident rights, such as refusing treatment? You can also ask to review the admission contract, learn about costs and refund policies, and understand how care decisions are made if the resident is unable to speak for themselves. Want more questions to ask? Visit our full guide: Is This the Nursing Home to Choose?  It includes detailed sections on services, nursing care, residents' rights, and conversations to have with administrators, staff, and families. At Kansas Advocates for Better Care, we believe everyone deserves compassionate, dignified, and person-centered long-term care. Asking the right questions is the first step to getting it.