As Senators began hearings on the challenges facing the health care sector Thursday, nursing home advocacy groups redoubled their calls to lawmakers to end the three-day hospital stay requirement for the skilled nursing industry, noting difficulties facing the sector, especially amid staffing shortages.
LeadingAge, which represents more than 5,000 nonprofit aging services providers, sent letters this week to Congressional leaders and federal officials calling for doing away with the three-day stay policy, terming the requirement, “an outdated policy that presents unnecessary barriers to care.”
“During the COVID-19 pandemic, it became clear that requiring a mandatory, three-day hospital stay for everyone who is ready to enter a nursing home is wasteful and ineffective,” said Katie Smith Sloan, president and CEO of Leading Age, in a press release.
The end of the public health emergency means that waivers for the three-day stay as well as other provisions will also be gone, increasing burdens.
Ahead of the hearings, LeadingAge also shared results with lawmakers from its survey on challenges facing the industry. The organization conducted the survey in June 2022.
The LeadingAge survey showed that the labor shortages for its providers stemmed from high staff turnover, recruiting difficulties, and decreased retention rates due to low wages and burnout among staff. This trend was exacerbated by a weak pipeline of nursing home workers.
CNAs were the most difficult for 52 percent of the respondents to recruit, while 24 percent had difficulty attracting Registered Nurses (RNs), and 9 percent had difficulty hiring Licensed Nurse Practitioners (LPNs).
The result of this staffing shortage is that more than 42% of LeadingAge’s survey participants indicated they were experiencing “significant challenges” in their ability to admit patients. Also, 25% of the respondents had challenges so difficult that they had to shut down units or buildings, the survey results suggested.
Staffing shortages and their impact, though not unique to the skilled nursing sector, did dominate the discussion at the Senate Health, Education, Labor and Pensions (HELP) Committee hearing, with several senators eager to resolve the crisis.
“We have to make sure that we care for our health care workers,” said Sen. Edward Markey, a Massachusetts Democrat. “(Our) healthcare heroes who get into their careers to help people in their greatest hour of need are facing their own hour of need. The current system is forcing them to make impossible choices when faced with huge caseloads, immense pressure, intense burnout. So advocates and healthcare unions across the country are fighting to make sure we can keep our workers on the job through better pay and safer working conditions. But without enough of these critical workers, health care centers are closing their doors, turning people away,” he said.
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), that represents more than 14,000 nursing homes and assisted living communities, said that after three years of the pandemic, more than 80% of providers are still facing moderate or high levels of staffing shortages.
“Even after taking unprecedented steps to support our workforce, nursing homes have experienced the worst job loss of any health care sector,” said Mark Parkinson, president and CEO of AHCA/NCAL, in a press release, adding, “At our current pace of moderate job growth, we will not return to pre-pandemic workforce levels until 2027.”
As for eliminating the three-day hospital stay rule, which has been in existence for more than 50 years, nursing home advocates have long argued for ending it.
LeadingAge said that skilled nursing facilities (SNFs) are capable of providing residents with the same routine care offered at hospitals, rendering the policy expensive and needless. Also, the group pointed to audits that showed patient outcomes were unaffected during the time nursing homes were able to avail the waivers for the three-day requirement. Meanwhile, the policy often disproportionately impacted disadvantaged population groups, LeadingAge said.
“(L)lengthening hospital stays can be challenging for older people—especially those with cognitive impairments. These inequities, created by the current requirement, should be removed immediately.”
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