As the federal staffing minimum mandate proposal and study is due to be revealed in a matter of months, some state leaders are calling on the Centers for Medicare & Medicaid Services (CMS) to rethink the mandate’s “one-size-fits-all” approach.
Thirteen senators across nine rural states last week issued a letter addressed to CMS Administrator Chiquita Brooks-LaSure, concerned the proposal would significantly affect access to nursing home care in more remote markets.
On the heels of the letter, NBC News’ report on small-town nursing home closures illustrated what dwindling access to care looks like as a result of the ongoing staffing crisis. The report follows the closure of an Evangelical Lutheran Good Samaritan Society facility in Postville, Iowa, and fallout for its residents since September.
The Evangelical Lutheran Good Samaritan Society, one of the largest skilled nursing providers serving rural markets, announced a strategy to consolidate its operations from 22 states to seven earlier this month.
Senators worry the staffing mandate would result in additional closures across rural America, as a result of a disproportionate financial burden placed on such facilities.
In Montana, 11 nursing homes have closed since 2021 – the state last year lost more than 850 nursing home beds, according to the Montana Health Care Association.
On a national level, the skilled nursing sector has lost 210,000 jobs from February 2020 to December 2022, according to the American Health Care Association’s (AHCA) aggregation of data from the Bureau of Labor Statistics (BLS).
About 80% of nursing homes are “very concerned” about the staffing mandate, according to a survey of AHCA/NCAL members. Operator concerns are justified in the data – in order for facilities to meet a staffing minimum of 4.1 hours per resident day (HPRD), 191,000 nurses and nurse aides are needed; that’s an annual cost of $11.3 billion, based off an updated report released by accounting and consulting firm CliftonLarsonAllen (CLA).
Mark Parkinson, president and CEO of AHCA and the National Center for Assisted Living (NCAL), said the year-end 2022 data puts the nursing home workforce crisis in “stark perspective.”
Both AHCA/NCAL and fellow aging services group LeadingAge don’t support the federal staffing mandate as it stands. When the initiative was first announced as part of the Biden administration’s reforms in February 2022, the groups said the mandate needs to be supported by both state and federal dollars and also take into account the staffing crisis.
The senators invited CMS to work with Congress to come up with “tailored solutions” that take into account workforce challenges in underserved areas.
“For example, minimum staffing standards that establish strict staff-to-patient ratios and/or minimum hours per resident day requirements may not reflect optimal staffing levels given differences in patients’ needs and underlying conditions, as well as the skills of the personnel at-hand,” senators wrote.
U.S. Senators Jon Tester (D-MT), John Barrasso (R-WY), John Hickenlooper (D-CO), and Steve Daines (R-MT) sent the letter on Friday.
Senators John Thune (R-SD), Gary Peters (D-MI), Kevin Cramer (R-ND), Joe Manchin (D-WV), Deb Fischer (R-NE), Kyrsten Sinema (D-AZ), John Hoeven (R-ND), Cynthia Lummis (R-WY), and Mike Rounds (R-SD) also signed the letter.
“We stand ready to work with your agency on proposals to improve long-term care for patients. The best way to accomplish this goal is working with Congress and stakeholders to ensure any future actions do not further exacerbate the serious challenges already facing facilities in rural America,” they wrote.
Companies featured in this article:
AHCA/NCAL, CLA, CMS, Evangelical Lutheran Good Samaritan Society, LeadingAge, Montana Health Care Association, NBC News
