Nursing home industry leaders, more than 500 of whom gathered on Capitol Hill this week to influence workforce legislation, sounded alarms over the possibility of a minimum staffing rule at the conclusion of their meeting with policy makers Tuesday.
At a time when the industry is still reeling from the effects of massive worker shortages that were worsened during the pandemic, and as the sector lags other areas of health care in recovering from labor challenges, nursing home executives and advocacy group leaders said any minimum staffing measure would be punitive.
“[A staffing minimum] will make things worse. It will cause beds to shut down. It will cause wings to close, and unfortunately, it will accelerate the closures of nursing homes,” said Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). “I know that the folks that want to do this are well-intentioned, but the results will be the opposite of what they want. Seniors will not be benefited. They will be hurt because access will decline,” he said.
Parkinson said that the industry is willing to hire workers, but the workers simply aren’t available.
“We want more staff … so to now punish providers that are unable to hire staff, it just makes no sense. It flies in the face of what’s actually on the ground,” Parkinson said.
A federal minimum staffing rule is under review by a federal budget office, and will likely be released any time between June 9 to June 21 – the last day of spring, according to industry leaders.
Nursing home providers shared their view on how to resolve the problem using immigrant nurses, more federal funding and educational initiatives, among other means.
Nate Schema, President and CEO, Good Samaritan Society, said that his organization has launched initiatives that have helped, but that also require more funding. These include increased wages, added bonuses, flexible scheduling options, benefits, well-being support, and training programs for leaders and caregivers – all solutions that are expensive but beneficial, he said.
Good Samaritan is the largest not-for-profit provider of senior care and services in the nation, with more than 200 locations across 22 states and 140 nursing homes. Of these, about 70 percent are located in rural communities, mainly in the upper Midwest.
“While modest, we’re seeing some job recovery across the Good Samaritan Society. Our turnover rate has lowered and employees consistently tell us the work they do is meaningful and their residents are family,” Schema said, adding, however, “An unfunded minimum staffing mandate will undo the progress we’ve made … The bottom line is that an unfunded staffing mandate will reduce access to care for seniors in rural America. Is this a reality our country is willing to accept?” Schema asked.
Parkinson said that while immigration would be the easiest solution, “the political dynamics” in Congress have not come together. Meanwhile, AHCA/NCAL has advocated for steps that might meet less resistance including a visa program for healthcare workers. This could facilitate bringing in CNAs, LPNs and RNs to the U.S. Other useful legislation includes extension of the Temporary Nurse Aide (TNA) program as well as a program that allows CNA schools that are based in care facilities to continue.
“So there are solutions out there. We need help. We need Congress and the administration to coalesce around the sector and provide solutions to our workforce problems,” Parkinson said.
Leaders also decried inadequate Medicaid reimbursements adding to the current staffing problems that an unfunded minimum staffing rule will further complicate.
Sarah Schulman, Vice President of Operations at Brookside Rehabilitation and Wellness in Castle Rock, Colorado, said that at her organization 85% of the residents are on Medicaid, which has meant a huge loss of income.
“As we all know too well Medicaid reimbursement rates do not fully cover the cost of care. We were losing $16,500 per resident per year because of inadequate funding. If you quickly do the math, you can understand how this would put us in an unstable financial situation,” Schuman said.
Low Medicaid rates, the drying up of funds from the public health emergency along with rising costs has not boded well for Brookside, she said.
“What worries me about an arbitrary staffing ratio is that it will do nothing to help build our talent pool and only add to our costs. How will we find these workers without resources when Medicaid is already underfunded?” Schulman asked. “These are the questions that so many providers are asking. A nursing home cannot raise its rates or adjust hours. We are open 24 hours a day, seven days a week because we take care of our most vulnerable citizens. We can only do so much on our own.”
Parkinson also shared results of a new survey that underlines the workforce challenges faced by long term care providers.
About 95% of the respondents have indicated that it’s still difficult or somewhat difficult to recruit new staff despite more than 95% of providers having increased wages. Meanwhile, nearly a third of nursing home providers said that their workforce situation has actually gotten worse since the end of 2022. Moreover, all of those surveyed said they were having staff work overtime and complete extra shifts. And many providers continue to use agency workers, with 75% reporting the use of these temporary workers.
In states where the unemployment rates are especially low, a minimum staffing rule will pose additional challenges, including from employment of agency workers.
“So many of us are backed into a corner,” Coleen Condon, owner of Suncrest Healthcare Communities in St. Albans, Vermont. “I can either limit resident admissions or hire expensive staffing agencies, [and] limiting admissions bleeds into our other health care sectors.”
Condon said that a “one size fits all” staffing requirement will only force nursing homes to use expensive staffing agencies, the use of which has shown to diminish quality of care while also being financially unsustainable for facilities.
“We truly have a crisis, and the proposed federal staffing mandate will exacerbate the situation. All long-term care residential facilities are unique and need to be staffed according to their specific various specialties … Lawmakers should instead advance supportive policies that will build a strong pipeline of dedicated caregivers,” Condon said.
Companies featured in this article:
AHCA/NCAL, Brookside Rehabilitation and Wellness, Good Samaritan Society, Suncrest Healthcare Communities
