“The only way to assure there is enough staff in a skilled nursing facility is to implement a minimum staffing requirement.”
When you hear or read statements like this from a member of Congress, a staffer at CMS or the White House, or a well-intended healthcare research expert, how does that make you feel? I know I feel a strong sense of frustration and disappointment.
Setting a minimum staffing requirement in no way assures there will be enough staff to address the needs of older adults needing skilled nursing care. It is “political theater” at best, and at its worst, it further endangers the ability of providers to best meet the needs of present and future residents.
Today there are not enough long-term care nurses and aides to meet the needs of older adults in skilled nursing facilities (or hospitals, home care agencies, rehab/transitional care centers, hospice providers, doctors’ offices, etc.). Today there are more open RN, LPN and CNA positions in our field than there are staff to fill them. When you include the desire for well-qualified staff, the competitive environment among all healthcare providers, and the growing population of older adults, it further suggests a governmental edict, such as a minimum staffing requirement, will ensure there is/will be enough clinical care staff is inaccurate.
A more rational approach would be the development of a comprehensive plan to address the challenge long-term services and supports providers are facing. A plan that:
Incentivizes experienced long-term care clinicians who left the field over the past three years largely due to COVID to come back to the field as much-needed educators/mentors. Nursing schools are struggling to find qualified people to train future nurses and aides. We also need to work together… government, nursing schools, providers and healthcare grantmaking organizations to develop and fund initiatives that will attract future clinical care providers to our field.
Reforms immigration laws, thereby improving the opportunity and ability to recruit foreign clinicians to work in the USA in order to expand the workforce pool. Years ago, Dr. Robyn Stone led a study that found foreign-born nurses provided high-quality care when given the opportunity to do so in our country. Incent and connect nonprofit agencies (such as Lutheran Social Services) with a worldwide reach to work with LTC/SNF providers in recruiting foreign-born clinicians.
Provides funding and accessibility resources for evidence-based best practices training relative to SNF clinical care. Better-trained staff will help make the provision of care more efficient and effective.
Considers tort reform that supports appropriate punitive damage to providers in cases of criminal negligence and/or criminal malpractice. Reform should seek to limit unreasonable economic damages for historically solid providers. SNF providers are getting inundated with claims that should not reach the level of criminal negligence or criminal malpractice and negatively impact liability insurance costs to providers.
Studies all government-funded reimbursement programs (Medicaid, Medicare, Medicare Advantage, MA Special Needs Plans) in long-term care. Why should providers participating in the Medicaid program have to beg to receive at least 90% of our cost as reimbursement? Create a formula setting reasonable expenses in a defined market area that gets reviewed on a set basis and reimburse at 100% of cost. In all programs consider incentivizing providers based on clinical outcomes and financial stewardship. Assure that the provider… who is actually providing the hands-on and necessary care… is not carrying an unreasonable amount of risk participating in these programs while not receiving a fair and reasonable reimbursement.
Now, where are there opportunities to fund these initiatives in a comprehensive plan?
Stop talking and finally create a federal and state survey model that is reasonable and fair and utilizes fines accrued through the punitive nature of the program to fund needed clinical staff training and purchase/access to needed equipment to providers who have shown an ability to improve over a period of time through access to these funds. Habitual poor performers would not have access to these funds (and other funding programs) until and only if their performance warrants access. A number of studies suggest that the present survey program is “better than nothing,” but findings in a number of studies over the years suggest it does not improve the quality of care in SNFs. The heavy-handed regulatory environment also impacts the ability to recruit and retain people for key positions such as Administrator and Director of Nursing.
Work with the Center for Aging Services Technologies in identifying technologies that can improve the efficient delivery of care in SNF settings. Promote ROI (return on investment) models for providers to consider and should the ROI have a positive impact on savings to federally funding programs, use a portion of that savings to make it easier for providers to acquire such technology.
Effective tort reforms will hopefully “level off” the ever-rising costs of liability insurance coverage so these savings can be used by providers more effectively. Support the movement of reciprocal risk retention groups in our field as another measure to better manage the rising costs of liability coverage and unreasonable legal claims.
Bring back the consideration of developing a federal program for working people to set aside funds for their future long-term care needs through their paycheck deductions. This is not an entitlement program. It is a program to leverage the investments people are making for future LTC needs, and at a minimum, it gets people to consider and possibly plan for LTC needs down the road.
Rebalance the reimbursement share in government-funded programs so providers are only carrying a reasonable share of the risk and receive fair and adequate reimbursement. Increasing reimbursement to providers will help us invest more in the staff providing care and the staff who support the provision of quality care through living/competitive wages, acquire useful technologies enhancing care and efficiency of resources, improve training and development, and reward excellence.
Quality providers welcome increased reimbursement opportunities tied to the level of acuity, clinical outcomes and fiscal stewardship. Each day over the past 20 years, the number of nursing home beds has been in a freefall as the population of older adults grows. Many older adults need and are best served in a skilled nursing facility. SNFs have invested significant funds in creating welcoming and engaging environments and programming for the people they serve. We need to invest in long-term care.
We need to stop “kicking the can down the road” of addressing long-term skilled nursing care. Our older adult citizens and the organizations striving to meet their needs and ambitions deserve better. It is time for a comprehensive plan.
Joe Xanthopoulos is the Chief Executive Officer/Executive Director of Florida Presbyterian Homes. Joe has 30+ years of experience as a leader and consultant in acute care health systems and long-term services and supports. In 2005 Joe received the AAHSA (now LeadingAge)/Ziegler Graduate Fellowship in Strategic and Financial Planning and attended the Harvard Business School workshop on Strategic Planning.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
