The Centers for Medicare and Medicaid Services’ admitted lack of a plan thus far for the $75 million it intends to use to spur development of more nursing home workers is further puncturing providers’ hopes for helpful change.
Regulators gave a revealing view of their lagging progress in a letter to LeadingAge president and CEO Katie Smith Sloan.
The CMS missive — dated June 7, but delivered to LeadingAge Monday and published Wednesday — was a response to an earlier request from LeadingAge for information on the campaign. The nonprofit association’s letter embodied industry hopes and concerns about how much the federal government would be able to aid nursing homes following the announcement of the federal staffing mandate in late April.
In both the letter and a linked FAQ resource, CMS leadership continues to project confidence that its $75 million upcoming investment will provide a notable boost to long-term care providers’ staffing challenges. The campaign is still in the planning stage, however, and detailed estimates are not yet available, wrote CMS Administrator Chiquita Brooks-LaSure.
“Currently, we are conducting comprehensive research to help inform the structure of … the campaign,” she wrote. “For example, and per your question, we are researching the types of strategies and messages that could be implemented to motivate individuals to come work in nursing homes.”
Brooks-LaSure referenced an upcoming “large awareness campaign” and central CMS website that would be used to boost awareness of financial incentives for state-approved nurse training programs. The $75 million in funding will begin to be distributed in 2025, according to CMS, and will be drawn from federal civil monetary penalties.
Concerns grow
Sector leaders told McKnight’s Long-Term Care News they continue to be concerned about the extent and timeline of the financial help being offered by CMS. If it were to be doled out to each facility directly, it would amount to less than $5,000 per US nursing home.
“We do not have any details on timeline or the mechanisms of the campaign at this time, nor do we have an outline of the awareness campaign,” Janine Finck-Boyle, vice president of health policy at LeadingAge told McKnight’s Thursday.
“The funds barely scratch the surface of what’s needed to recruit, train and pay the additional professionals that would be required to meet the mandate,” she continued — noting that LeadingAge and its partners are actively working to retain workers by offering “career ladders and lattices.”
The $75 million campaign works out to an average of only $1.5 million per state, noted Melissa Brown, COO at Gravity Healthcare Consulting — a number she said was “shockingly low.”
“It is highly doubtful that anything meaningful can be achieved with that paltry sum per state,” she told McKnight’s Thursday. “While any funding is greatly appreciated, it is entirely unrealistic to think that this amount of funding will actually support the staffing mandate.”
Brown explained that funding the campaign through civil monetary penalties prohibits CMS from being able to use the funding for nurse salaries.
CMS acknowledges this fact in its linked Q&A sheet, but asserts that a lack of financial transparency in nursing homes makes it difficult to use federal funding for salary increases.
“While there may be situations where the existing payments do present challenges to funding the costs for nurse staffing,” the CMS Q&A states, “there are other situations where the costs can be funded, but the organization has made a budgetary decision not to fund certain costs.”
This may be a reference to the use of related-party transactions, sometimes called tunneling — often criticized by consumer advocates and policymakers skeptical of nursing home finances.
Those reservations from CMS, however, have potentially left nursing homes without substantial help they need to meet government demands, Brown said.
“It is very unclear how CMS plans to use the funding as CMS admits that they are currently researching how to leverage the funding. With no clear plan and the existing limitations, this will likely make a tiny dent in a very large, looming problem. Advocacy is critical at this point. Providers cannot allow this unfunded staffing mandate to remain, especially when the research shows that more staffing does not equate to higher quality or outcomes.”
