WASHINGTON, DC — Long-term care advocates and providers from several states rallied Tuesday for relief from a staffing rule they say will be impossible to meet, despite their shared interest in hiring more direct care workers.
The comments came in a rare joint press conference featuring the leaders of the sector’s two largest associations, the American Health Care Association/National Center and LeadingAge, as well as representatives from the National Rural Health Association and the National Association of State Veterans Homes.
“I think I can speak for the entire room in saying everyone here wants more staffing in facilities. Our members want it, associations want it. Unfortunately, the staffing mandate does not solve the problem and in many respects, it makes it worse,” said AHCA President and CEO Mark Parkinson.
In addition to reiterating many of the logistical challenges providers will have in meeting the mandate’s requirements for 3.48 hours of daily direct care and 24/7 RN care, the speakers tried to illustrate the impacts both at the individual facility level and across broad community or resident groups.
Parkinson noted that the rule would disproportionately affect nursing homes with a high share of Medicaid residents, whose care is reimbursed at a lower level than patients on Medicare.
“It means that the poorer people who are in Medicaid facilities will have less access to care because those facilities will be completely unable to meet this requirement,” he said. “Health inequities will grow.”
LeadingAge President and CEO Katie Smith-Sloan pushed back against the idea that the rule would improve nursing home quality by making providers portrayed as profiteering by the administration hire more nurses and aides.
She said her nonprofit members “know deeply the essence of caregiving,” often with storied histories in their communities. They also are worried about non-compliance and the threat the data reveals about workforce realities, she said.
Workforce woes continue
Between 2021 and 2031, Sloan said the nursing workforce would need 9.3 million direct care workers, including enough to fill one million new jobs.
“There are simply not enough nurses in the United States to fill the positions that are currently open in long-term care settings and Schools are not graduating enough nurses,” she said. “We are opposed to this mandate because it does not acknowledge the interdependence of funding, care, staffing and quality.”
The unintended consequences of lagging funding are apparent even before the mandate begins requiring more workers, she added. A provider in rural Connecticut has reduced its bed count from 91 to 65 beds, while Maine, with the oldest population in the US, has lost 40% of its SNF beds.
Patricia Horn, co-owner and administrator of the independent Cedar Hill Continuing Care Community in Vermont, said it may take her months to get an applicant for an RN job, a fact that has her “gravely” concerned. She struggles to staff weekend RN shifts, and can’t afford to pay agency or travel nurses for that role. Temporary LPNs in her area draw $80 an hour.
She has at times repurposed her HR director into a dietary director and also put her own husband to work as a part-time dishwasher and dietary aide. But, she notes, she can’t create licensed and credentialed caregivers.
Exemptions out of reach in some rural states
AHCA officials said Tuesday that no providers in the largely rural states of Nebraska, South Dakota or Wyoming would qualify for an exemption that requires the local labor pool to be 20% smaller than the national average. Horn told McKnight’s Long-Term Care News she also feared providers in many pockets of Vermont would be ineligible for exemptions, based on that CMS criteria.
Nate Schema, CEO of the Good Samaritan Society, illustrated his concerns by sharing the story of Howard Lake in Minnesota and Canistota in South Dakota.
The 32-bed Howard Lake has a turnover rate of just 22%, but when staff is needed, it can take a year to fill RN and CNA roles. The already 5-star rated building will have to hire three new RNs to comply with the mandate.
Less than 5% of Good Sam facilities nationwide would meet the mandate. Adding inflexible requirements is “dangerous and unnecessary,” Schema said, because many facilities have found individual ways to foster quality care.
He noted that the contributions of activities staff who strengthen Canistota’s behavioral health program would not be counted under the staffing rule, although those employees are responsible for resident engagement that helps define quality care.
“Is our 5-star facility in Howard Lake or our behavioral program in Canistota the type of nursing home the administration wants to put out of reach for our nation’s seniors?” Schema asked. “The residents and families we serve and the caregivers who have dedicated their life to the work are worth fighting for.”
