Nursing home staffing provisions in the Build Back Better Act so far remain unchanged — and unfunded — as the bill works its way through the Senate.

That’s according to panelists at a Tuesday telepress conference hosted by senior housing and care industry association LeadingAge.

The Build Back Better Act (HR 5376), which broadly aims to expand the social safety net for millions of Americans, passed 220-213 in the House mid-November; Senate Majority Leader Charles Schumer (D-N.Y.) seeks to pass the bill by Christmas, reports said.

Two provisions in the legislation, mandatory minimum staffing and 24-hour registered nurse (RN) oversight in nursing homes, made it past the latest round of negotiations in Congress without any changes, panelists said — it’s a positive and a negative, since the provisions are sorely needed in the industry but are currently unfunded by the government.

“Without funding to support increased staff, without meaningful policies to improve workforce supply, they’re only going to accelerate the workforce crisis and reduce older adults’ access to services,” said Charlotte Haberaecher, president and CEO of Lutheran Services in America.

Haberaecher noted the 24-hour RN provision would require hiring an additional 21,000 nurses, costing about $2.5 billion a year, both estimates published by the American Health Care Association (AHCA).

If mandatory minimum staffing increases by 25%, a “reasonable expectation” according to AHCA CEO Mark Parkinson, 150,000 more direct care workers would be required to meet hourly requirements. If this provision stays in BBB, Health and Human Services (HHS) would conduct a survey to determine staffing increases.

“The pandemic has reinforced how dangerous working and living in nursing homes can be if they’re not properly resourced and funded,” said Robert Espinoza, vice president of policy for PHI National. “It’s important that we think about how we can improve financing for nursing homes and how we can strengthen the overarching long-term care system, and as part of that, of course, strengthen the workforce.”

The two provisions together would cost the industry an estimated $13.5 billion per year.

During the virtual conference, Espinoza and Haberaecher, along with other panelists on the call, championed the Biden administration’s Build Back Better Act as a “long overdue” investment in the post-acute part of the care continuum.

But while the nursing home provisions have remained intact so far, other aspects of the bill could change.

Specifically, a $150 billion expansion of Medicaid’s home and community-based services (HCBS) and improving compensation for all direct care workers could potentially change, Espinoza said.

In a subsequent email to Skilled Nursing News, Espinoza said he is concerned the HCBS amount may be reduced in Senate negotiations: “I don’t have any intel suggesting that this is happening, but advocates are already calling on the Senate to keep this investment at the same funding level as the House.”

Other measures in Build Back Better will affect the nursing home industry indirectly, added Espinoza, including paid family leave and medical leave expansions, and measures to promote workplace equity.

“Many workers do not have access to paid leave which makes it impossible for them to stay healthy on the job, and it can ultimately hurt the care that they’re delivering to people in nursing homes. So if that passed, that would make a tremendous contribution to the nursing home sector,” said Espinoza. “Anytime we invest in equity, we ultimately invest in direct care workers because so many of these workers are women, people of color and immigrants.”

LeadingAge President and CEO Katie Smith Sloan led the discussion. Other participants in the conference included: Karyne Jones, president and CEO of the National Caucus and Center on Black Aging; Kristen Kiefer, chief advocacy and engagement officer for the National Council on Aging; and Jatrice Marten Gaiter, executive vice president, external affairs with Volunteers of America.