The outlook for compliance with the new nursing home staffing mandate took another dour turn Tuesday.
The most recent KFF survey of nursing home staffing levels revealed that at least 95% of facilities in four states — Arkansas, Tennessee, Texas, and Louisiana — do not meet the requirements of the federal staffing mandate. And the pain doesn’t end there.
As providers brace to meet the demands of the new rule from the Centers for Medicare & Medicaid Services while still facing an ongoing workforce shortage, many are scrambling to find local solutions to their staffing woes.
This week’s report reflects the latest and most detailed survey from KFF on where the long-term care sector stands in relation to the new CMS regulations that will roll out progressively over the next several years. A majority of nursing homes in 45 states — more than 80% overall — are not in compliance with the mandate.
The near-total lack of additional federal funding to support staffing increases continues to be a thorn in the side of provider leaders, such as Rachel Bunch, executive director of the Arkansas Health Care Association.
“We consider this an unfunded mandate,” she told McKnight’s Long-Term Care News Tuesday. “To date, the administration has communicated minimal information regarding how nursing homes can access resources intended to support recruitment, retention and training of workers.”
An unequal burden
Staffing challenges are not shared equally across the nation. While a majority of states have 25% or fewer facilities ready to meet the mandate, five states and Washington DC have 60% or more. All 16 facilities in Alaska are ready to meet all requirements for overall staffing hours, registered nurse hours and certified nursing assistant hours.
Rural and urban facilities are about equally prepared for the trio of staffing rules — meeting all three at rates of about 20% and 18%, respectively.
Approximately 40% of nonprofit and government facilities are currently set to meet the mandate completely, while only 19% of for-profit facilities can say the same.
In states like Arkansas, which have the most ground to make up, providers have found themselves leaning on state-level programs and funding to help cover that ground.
“We have certified 166 medication assistants over the past year and hope to do many more in the coming months,” Bunch said. “These are existing CNAs in our facilities that are now certified to assist nurses with med pass and allow the nurses additional time with patients. Now more than ever we see the opportunities to upskill dedicated staff members at our facilities into clinical positions and are exploring a number of ways to make that a reality.”
Bunch thanked the state government for a $20 million award to nursing programs across the state earlier this month. She told McKnight’s she hopes that state rules can be updated to increase the scope of certain clinical roles and streamline advanced certifications.
The need for such strategies is not limited to smaller, rural states like Oklahoma. Texas is also among the four states highlighted by KFF, while New York and California each have fewer than 25% of their facilities ready to match the mandate.
Providers in all three of those states have recently expanded or begun programs to bring young workers into long-term care, use unique advertising methods and “earn and learn” programs to attract new workers or even create completely free virtual nursing programs.
