While nursing home operators welcome more time to certify temporary nurse aides (TNAs), many believe it’s simply not enough — and must be just the first in a series of steps the federal government has to take — to help revive a seriously depleted workforce from top to bottom.
The Centers for Medicare & Medicaid Services (CMS) recently granted the sector extension opportunities by way of statewide or county waivers that will only last as long as the public health emergency (PHE) remains in place.
Consulate Health Care CEO Jeron Walker likened the extension to a “baby carrot,” a small win for the industry as operators continue to bolster net hires and reduce agency staffing, all while facing heavy scrutiny from CMS and the Biden administration.
The decision also comes at a time when barriers to testing and training are obvious in some cases.
Steve Flatt, CEO of senior care operator National HealthCare Corporation (NHC), said their team has used the program “extensively” across its seven regions, and the state of Tennessee in particular with the assistance of its TNA to certified nursing assistant (CNA) bridge program.
“Now we’re getting a little more latitude with the extension,” Flatt said of the agency’s decision.
Flatt, along with Walker and Trilogy Health Services CEO Leigh Ann Barney spoke about the latest regulatory update during a panel discussion at the Skilled Nursing News Rethink conference on Thursday.
NHC is currently assessing the situation on a facility-by-facility and state-by-state basis to maximize the extra time.
Louisville, Ky.-based Trilogy is down to about 300 TNAs from 1,000-plus prior to CMS announcing it would sunset the program, Barney said. The ones that are left are still with Trilogy because they want to go through the credentialing process.
“[They] should get some credit for on-the-job training, being in the trenches of working during Covid, but we’ll continue to monitor that. We’re pushing forward to get them all certified and appreciate a little bit of extra time,” Barney said.
Operators to CMS: Collaborate and listen
If given the opportunity to spend time with CMS officials and share one key industry priority with them, the need for collaboration and communication were common threads among each executive’s answers.
“Collaboration is the word,” Walker said on the panel. “If we have programs that incentivize creativity versus a one-size-fits-all, punitive approach, it’s going to lead to better outcomes for everybody.”
The skilled nursing sector needs a guaranteed seat at the table too. Government entities, especially those that don’t work in the space every day, need to listen to providers in order to better understand what will work and what won’t.
“Work with us as operators. We want to help find solutions. Don’t just go to these think tanks or decide to make these broad brush approaches to staffing,” added Barney. “Come talk to us. We have solutions. We understand that there’s not unlimited funding for these programs but we need to try to solve the problem.”
Barney refers to the looming minimum staffing requirement due to be unveiled in Spring 2023 as part of the Biden administration reforms; CMS is currently working on a study to determine the right ratio of staff to adequately care for nursing home residents.
Creating opportunities in the meantime
Operators aren’t waiting around for funding bumps from CMS or states though, much less more collaboration and understanding.
Many are either diversifying service lines for the first time or deepening their services across the care continuum as the cost of increasingly acute care outpaces Medicare and Medicaid reimbursement.
Behavioral health, palliative care and hospice are newer avenues for some operators. Institutional special needs plans (I-SNPs), professional liability insurance and even in-house workers’ compensation groups are other ways operators have diversified.
“We try to control as much of a continuum as we can,” Flatt said. “We’re constantly looking for ways to hedge our bets and not drop all our eggs in one basket.”
NHC dove into palliative and hospice care last year, acquiring outstanding stakes in Caris Healthcare for $38.95 million. The company also opened two behavioral health hospitals in Missouri and one in Tennessee, the most recent being a 16-bed geriatric hospital in July.
Behavioral health in particular, Walker said, is an area he sees expanding as the need for such services grows. Nearly 50% of Americans will be diagnosed with a mental health problem in their lifetime.
“With that comes a whole different set of staff that [operators] need, … a huge base of counselors, psychiatrists, psychologists,” Walker added.
Just like with CNAs, licensed practical nurses (LPNs) and registered nurses (RNs), he said, the speciality level for behavioral health services will really all depend on acuity and community needs.
And if behavioral health will increasingly become a big aspect of the skilled nursing sector – which Walker believes it will – they need to be counted in any federal or state staffing minimum requirement.
Companies featured in this article:
Centers for Medicare & Medicaid Services, Consulate Health Care, National Healthcare Corporation, Trilogy Health Services
