What Share of Nursing Facilities Might Meet Proposed New Requirements for Nursing Staff Hours?

On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would create new requirements for nurse staffing levels in nursing facilities, settings that provide medical and personal care services for nearly 1.2 million Americans. The adequacy of staffing in nursing homes has been a longstanding issue. A recent report issued by the National Academy of Sciences, Engineering, and Medicine (NASEM) raised concerns about low nursing staff levels in nursing facilities across the country and the impact on the quality of care for nursing home residents. The high mortality rate in nursing facilities during the COVID-19 pandemic highlighted and intensified the consequences of inadequate staffing levels.

The new proposed rule includes several provisions to bolster staffing in nursing homes. It proposes a minimum of 0.55 registered nurse (RN) and 2.45 nurse aide hours per resident day; requires facilities to have an RN on staff 24 hours per day, 7 days per week; strengthens staffing assessment and enforcement strategies; creates new reporting requirements regarding Medicaid payments for institutional long-term services and supports (LTSS); and provides $75 million for training for nurse aides. As noted in the proposed rule, CMS aims to balance the goal of establishing stronger staffing requirements against the practicalities of implementation and costs. Comments on the proposed rule are due by November 6, 2023.

This issue brief analyzes the percentage and characteristics of facilities that would meet the rule’s proposed requirements for the minimum number of RN and nurse aide hours to better understand the implications of the rule. The analysis does not evaluate facilities’ ability to comply with other requirements, including the requirement to always have a registered nurse on duty 24/7 or the ability to meet the new reporting and assessment requirements due to data limitations (see methods). The analysis uses Nursing Home Compare data, which include 14,591 nursing facilities (97% of all facilities, serving 1.17 million or 98% of all residents) that reported staffing levels in August 2023.

Click here to read more and to access the brief.

Here You Can Read about Higher Buprenorphine Doses and Opioid Use Disorder Treatment Study

Individuals with opioid use disorder (OUD) who were prescribed a lower buprenorphine dose were 20% more likely to discontinue treatment than those on a higher dose, according to a study of patients prescribed buprenorphine in Rhode Island from 2016 to 2020, as fentanyl became widely available. “The current recommended target dose of buprenorphine was derived from studies conducted prior to the widespread availability of fentanyl. Now, we’re seeing people with higher levels of tolerance to and dependence on opioids, and our findings suggest that a higher buprenorphine dose – up to 24 mg – may help improve treatment retention for these individuals,” said Rachel Wightman, M.D., Associate Professor of Emergency Medicine and Epidemiology at Alpert Medical School of Brown University and one of the principal investigators of the study.

This New Bulletin Provides Updates to Childhood Nutrition and Weight Management Services

The Pennsylvania Department of Human Services, Office of Medical Assistance Programs has issued a new bulletin. The purpose of this bulletin is to advise providers enrolled in the Medical Assistance (MA) Program of the expansion of Childhood Nutrition and Weight Management Services (CNWMS) for MA beneficiaries under 21 years of age to include pharmacotherapy as a result of changes to coverage of obesity drugs and updated guidance from the American Academy of Pediatrics (AAP). The bulletin also addresses coding changes as a result of the 2023 Healthcare Common Procedure Coding System (HCPCS) updates.

The Rate of those Uninsured Has Dropped to 5.3% in 2022

The uninsured rate in Pennsylvania dropped to 5.3% in 2022, down from 5.5% in 2021, according to new data from the Census Bureau. Only 10 states had lower uninsured rates in 2022 – Connecticut, Hawaii, Iowa, Massachusetts, Michigan, Minnesota, New Hampshire, New York, Rhode Island, and Wisconsin. Twenty-seven states had a higher percentage of people with health insurance coverage in 2022 than in 2021 according to American Community Survey (ACS) 1-year estimates released today by the U.S. Census Bureau. In terms of uninsured rates, or the rate of people without health insurance, Maine was the only state where the uninsured rate increased (up to 6.6% in 2022, from 5.7%). Between 2021 and 2022, the rate of public coverage increased in Pennsylvania and 12 other states (Alabama, California, Georgia, Illinois, Indiana, Michigan, Minnesota, Missouri, Nebraska, New York, Oklahoma, and Virginia) and decreased in one (Rhode Island). Oklahoma had one of the highest increases in public coverage (up 2.3 percentage points) from 2021 to 2022.

A New Report Has Been Released Analyzing Rural Syringe Service Programs in Appalachian Kentucky

  A study published in The Journal of Rural Health is based on interviews with clients and staff at five syringe service programs.  Questions covered the fidelity of implementation to six core components of syringe service programs, including meeting needs for harm reduction supplies, cooperation with local law enforcement, and ensuring low threshold access to services.

Black Bisexual Women in Rural Areas Are At Highest Risk for Suicidal Behaviors

Penn State College of Medicine-led research study highlights how gender, sexual orientation, race, ethnicity and rurality contribute to suicide ideation, planning and attempts

Non-Hispanic and Hispanic Black bisexual women who live in rural areas have the highest prevalence of experiencing suicidal thoughts and behaviors, according to a Penn State-led study. The researchers said this “first-of-its-kind study,” published in JAMA Psychiatry, revealed how various demographic factors intersect to affect a person’s risk of having suicidal thoughts and behaviors.

An estimated 12 million adults in the United States think about suicide every year, with nearly two million attempting suicide annually. While previous studies have examined how individual demographic factors, like race and gender, individually associate with suicide risk, no studies have demonstrated how different factors combine to influence overall risk. Lauren Forrest, assistant professor of psychiatry and behavioral health at Penn State College of Medicine, analyzed annual National Survey on Drug Use and Health responses from more than 189,000 individuals who provided information on their gender, race, sexual orientation, ethnicity and how rural their environment is, to study how these factors intersect or combine to affect risk of suicidal thoughts and behaviors. The researchers analyzed data from 2015 to 2019.

“We already know that some groups — like LGBTQIA+ individuals or women — are at increased risk for suicidal thoughts and behaviors,” Forrest said. “However, every person possesses multiple identities — including gender, race and sexual orientation, to name a few. Some combinations of identities, for example, Black bisexual women, may be associated with unique suicide risk profiles. But we can’t see these unique risk profiles if we only look at one identity at a time, which is what we’ve been doing thus far in research. It’s important to investigate how prevalence of suicidal thoughts and behaviors varies across intersectional identities, so we can identify populations most at risk and develop interventions specifically for those groups and their unique experiences driving their suicidal thoughts and behaviors.”

The researchers found that the intersectional group with the highest prevalence of suicidal ideation was Hispanic bisexual women living in rural areas — 20% of whom had thought about killing themselves in the last year before they took the survey. By contrast, the intersectional group with the lowest prevalence of suicidal ideation was Hispanic heterosexual men living in large metropolitan counties, where only 3% had contemplated suicide in the year before completing their surveys.

Forrest said the research is based on intersectionality theory, first proposed by Black feminist scholars. Intersectionality theory proposes that health inequities for any group — whether based on gender, sexual orientation, race and ethnicity and/or rurality — arise not due to people’s identities, such as gender, themselves but due to interlocking structural systems of power, privilege and oppression.

According to Forrest, a person can face various types of discrimination based on their gender, race, ethnicity, sexual orientation or simply by where they live. Discrimination can be experienced across levels of influence, which are layered, or nested, within one another. An individual person — the smallest level — is nested within an interpersonal network of peers, family, friends and immediate neighbors. That interpersonal network is nested within a community, and a community is nested within society — the structural systems — at large.

Structural discrimination occurs when there are laws that impose on certain individuals’ rights or welfare, and/or when certain prejudicial attitudes or behaviors are socially acceptable across society, Forrest said. For instance, laws opposing or restricting gay rights is an example of structural discrimination based on sexual orientation. This type of discrimination can set the stage for LGBTQIA+ people to experience more discrimination in their communities, since communities are nested within societies. This discrimination can become more intense on an interpersonal level, too, since interpersonal levels are nested within communities, which are nested within structures.

“When people face multiple types of structural discrimination, such as discrimination based on their sexual orientation and their race, which might be even more heightened in rural areas versus urban areas, it makes sense that the effects of discrimination could compound on one another,” Forrest said. “Discrimination, especially when it’s occurring across identities and levels of influence, is painful. Over time, these repeated and compounding painful discrimination experiences could ultimately contribute to some people contemplating or attempting suicide.”

According to Forrest, her research in this area is just getting started. She plans to continue studying how structural level risk factors, such as structural stigma, interact with individual-level risk factors, such as psychiatric disorders, to jointly impact suicide risk among LGBTQIA+ people living in rural areas. She said her ultimate goal is to collect and analyze data that can ultimately influence policy decisions, especially those relating to health equity.

“I’m passionate about this area of research because it’s important for mental health providers to understand that factors across levels of influence impact suicide risk,” Forrest said. “We often consider, assess and intervene upon individual-level risk factors, like psychiatric disorders. But I’d argue that we rarely, if ever, consider how the structural processes that drive health inequities may be impacting the person sitting in front of us in the therapy or assessment room.”

Forrest noted that better understanding how factors across levels of influence combine to impact suicidal thoughts and behaviors could help mental health professionals better determine the groups most at risk, determine the most potent intervention targets across levels of influence and develop and implement effective interventions for the underlying causes of health disparities and inequities (e.g., structural discrimination). She said that virtual interventions may be useful in rural settings where health care access may be limited and discrimination may be more severe, compared to more urban areas.

This research is part of Forrest’s training as a Penn State Clinical and Translational Science Institute KL2 Scholar. Project collaborators include Forrest’s KL2 mentor and senior author, Emily Ansell, associate professor of biobehavioral health at Penn State College of Health and Human Development and Penn State Social Science Research Institute scholar; Sarah Gehman, College of Medicine medical student; Cara Exten, assistant professor of biobehavioral health at Penn State Ross and Carol Nese College of Nursing; and Ariel Beccia of Harvard Medical School. The researchers declare no conflicts of interest.

This research was supported by the National Center for Advancing Translational Sciences through Penn State Clinical and Translational Science Institute. The views expressed are those of the researchers and do not necessarily represent the views of the National Institutes of Health.

If you or someone you know is experiencing suicidal thoughts or behaviors, help is always available. Call 988; contact the crisis text line by texting PA to 741741; call the Trevor lifeline, for LGBTQIA+ individuals, at 1-866-488-7386; and/or call the Trans Lifeline, for trans and gender diverse individuals, at 1-877-565-8860.

It’s Not All About Wages: What Workers Want In a Job

Enough money to cover the bills and help them get ahead. Fair treatment. Job security. Time to care for their families and themselves. These are things U.S. workers and job seekers without a four-year degree said they want in a job.

The topic of what makes a quality job emerged organically during listening sessions as part of the Worker Voices Project. Led by the Federal Reserve Banks of Atlanta and Philadelphia, Worker Voices looked beyond the numbers to understand the impact of the COVID-19 pandemic on how workers without a four-year degree perceive and navigate employment.

Worker Voices Special Brief: Perspectives on Job Quality takes a deep dive into a major theme that emerged during focus groups with 167 U.S. non-college workers and job seekers across the country — what workers want and expect from a job.

Read the report to learn more.

ADA Survey Report on Teledentistry Released

A new survey report was published from the American Dental Association Clinical Evaluators Panel. The report, “Teledentistry Adoption and Applications,” found that the adoption of teledentistry grew in the past three years, in part because of the COVID-19 pandemic, but the technology may be underused. Thirty percent of respondents said they use teledentistry, with 60% of users expressing satisfaction and noting increased access and quality of care, while 60% of those not using teledentistry said there wasn’t a need.

Click here to read the report.

Maternal Mortality Crisis and Extension of Medicaid Postpartum Coverage

Examining the effect of extended postpartum coverage brought by the American Rescue Plan Act of 2021, policy experts present evidence that ensuring access to care for 12 months after giving birth is a key strategy to address the U.S. maternal mortality crisis.  The authors note that Medicaid is used predominantly in rural areas and by individuals who are racial/ethnic minorities.  The latest data from the Centers for Disease Control and Prevention (CDC) show significantly higher rates of maternal death in 2021. A separate report from the CDC, out last month, reveals 1 in 5 women reported mistreatment while receiving maternity care, with clear disparities by race/ethnicity and insurance types.  The FORHP-funded Rural Health Research Centers have increased their work on this issue in the last three years, following an earlier determination that rates of maternal mortality have long been higher for rural residents.