The nursing home staffing mandate from the Centers for Medicare & Medicaid Services could save nearly 13,000 lives each year, researchers from the University of Pennsylvania estimated this week.
The researchers examined Payroll Based Journal data from CMS, as well as prior research on the link between minimum staffing laws and nursing home mortality rates in California.
Extrapolating the mortality decreases observed in that California study, the researchers estimated that 12,945 lives would be saved each year by bringing nursing home staffing up to staffing mandate levels. These estimated benefits would, to varying degrees, affect every state.
The researchers also noted that increasing staffing to the mandated levels would have a strong positive impact on other care outcomes, such as urinary tract infections, pressure sores and functional status.
“We believe there is strong evidence that the enforcement of CMS’ new rule would save a significant number of lives each year, in addition to reducing a number of adverse outcomes for residents,” wrote Rachel M. Werner, MD, PhD, executive director of the Leonard Davis Institute at UPenn, along with Norma Coe, PhD, director of research at LDI.
The analysis was commissioned by Sen. Elizabeth Warren (D-MA). On Saturday, she told USA Today that the number was “staggering” and that it was “shameful” for the nursing home sector to continue its opposition to the CMS mandate.
Long-term care sector leaders, meanwhile, have consistently maintained that improving nursing home care is more complicated than simply demanding more staff — especially given the severe shortage of workers and longstanding retention problems faced by nursing homes.
No displacements, closures noted
USA Today reported that the estimates do not address whether nursing homes might be forced to close due to more stringent staffing regulations, possibly displacing thousands of residents who need skilled care.
“Implementing a one-size-fits-all, impossible mandate that the majority of the nation’s facilities cannot meet is not a solution to improving care,” AHCA spokesperson Rachel Reeves, senior vice president of public affairs, told McKnight’s Long-Term Care News Monday. “The additional workers simply do not exist. All it will do is further reduce access to care by forcing nursing homes to downsize or close all together.”
Reeves cited an estimated 290,000 nursing home residents that could be displaced if the staffing mandate forces struggling facilities to close or downsize — also noting that residents who aren’t displaced may still face delays and other negative outcomes as a result.
“We all want to increase the nursing home workforce, but instead of blanket mandates amidst a growing caregiver shortage, we need resources and policies that will help providers recruit and retain more caregivers,” she continued. “Lawmakers on both sides of the aisle have shown concern about the negative consequences of this rule on residents and staff and have called on CMS to rescind the rule.”
In a response to the UPenn research, nonprofit association LeadingAge stressed its commitment to increased care but maintained that the mandate was not the right tool to use.
“We know that quality care and staffing are tightly connected,” wrote LeadingAge president and CEO Katie Smith Sloan. “While we agree on the goal of ensuring quality care, we disagree on the use of mandates to achieve it. The reason is simple: America’s current infrastructure of long-term care cannot sustain staffing mandates until they are supported by adequate funding and available staff. We are opposed to this mandate because it does not acknowledge the interdependence of funding, care, staffing, and quality.”
