WASHINGTON, DC — Skilled nursing providers cannot “blow off” a fast-approaching requirement to update their facility assessments using new elements, a sector top advocate warned here Tuesday.
The consequences could go beyond immediate compliance concerns tied to the assessment component of the new federal staffing mandate. The assessment needs detailed attention since it could become a tool in litigation against providers.
“I believe fundamentally that this facility assessment is really about the trial bar,” said Clif Porter, senior vice president of government relations for AHCA/NCAL, speaking at the association’s Congressional Briefing. “Ultimately, when you write down what your plan is, that’s a piece of paper that you’re held accountable to. … This is a means to strengthen not only enforcement but to strengthen litigious activities to ultimately put us in a situation that’s going to make delivering care that much more difficult.”
The Centers for Medicare & Medicaid Services is requiring facilities to update their assessments more often, and consider ways specific needs such as behavioral health, changes in condition or population swings might affect staffing needs. The facility must also involve residents, families and even worker representatives in developing a plan.
Every facility in the country must complete the new, expanded assessment by Aug. 10.
CMS has not yet issued specific guidance on how or how often to conduct the assessments, and providers have raised concerns about how they can ensure compliance given outstanding questions.
Porter noted that a facility’s best attempts to comply with a CMS-approved plan could be well-intentioned but backfire on technicalities, such as being able to find only a licensed practical nurse to fill in for a registered nurse who calls off when a facility assessment calls for RN coverage.
‘Craziest policy’
Kicking off a day of advocacy on Capitol Hill, Porter told a group of providers that the broader staffing rule is the “most existential policy risk” the sector has ever had and called the rule “insanity.” He encouraged providers to maintain decorum but be assertive in sharing just how severe the impacts of the mandate could be.
“Let me just call it what it is. This is the craziest policy conceived in my lifetime,” Porter said. “Now’s the time to get your elbows out a little bit, be a little more pointed.”
He pointed to reams of data, much of it created by the federal government itself, showing workforce challenges in long-term care. Those shortages have persisted ahead of the mandate kicking in, and in combination with funding shortfalls, are frequently cited as a reason for closures hitting some areas especially hard.
Porter noted the announcement of three closures in Pennsylvania this month, rural closures in general, and increasing closures in New England, especially Maine.
“You layer on top of that and that will create a tipping point that potentially could be cataclysmic, not only for our industry, but most importantly for the people we serve,” Porter said, noting that most facilities are already limiting access to care because of staff shortages. “We’re not filling up our buildings without having staff to take care of them. We have a responsibility. We’re licensed professionals, and we’re regulated.”
Retirement of nurses and the inability of nursing schools to crank out enough new nursing candidates will only further stress the care continuum, making hospital logjams worse should providers find themselves competing for more workers. He told providers to make sure their elected leaders knew of nursing shortages in their districts, and how those could persist for years.
“We have a structural nursing deficit in this country, and we, as a country, ought to do something about it. Let’s get nurses here that are waiting from the Philippines to get in our country and get honest work,” Porter said, mentioning oversupply of nurses in nations in the Philippines and Mexico and advocating for other solutions that could help nursing homes hire.
“This is not just recalcitrance on our part,” he added. “This is just us being real and not answering or kowtowing to any political interest.”
