OMB Still Analyzing Nursing Home Staffing Mandate, with Flurry of Stakeholder Meetings

As the staffing minimum mandate inches closer to an official release, associations with ties to the nursing home industry continue to meet this week with the Office of Management and Budget (OMB) – the government agency currently reviewing the proposal.

The Centers for Medicare & Medicaid Services (CMS) transferred the proposal to OMB for review on May 30, federal records show. Association leaders say they are encouraged to see so many stakeholders engaging with OMB as the proposed staffing rule is being reviewed.

Most recently, the National Rural Health Association met with the federal agency on Monday, according to the OMB registry. Meanwhile, the American Hospital Association (AHA) met with the agency Tuesday afternoon.

A spokesperson for AHA said the association expressed the same sentiments on the proposal as what was documented in a letter to CMS Administrator Chiquita Brooks-LaSure, jointly written with the American Health Care Association (AHCA).

“Mandating staffing levels is a simplistic, one-size-fits-all approach to the needs of complex and unique nursing home residents and patients,” AHA and AHCA said in the letter. “Specifically, staffing ratios are usually informed by older care models and do not consider advanced capabilities in technology or the interprofessional team-care model.”

The associations called for staffing levels to be a clinical decision customized to the resident population along with facility characteristics, instead of a policy decision made with “lack of regard to real-life situations.”

Also on Monday, Evangelical Lutheran Good Samaritan Society CEO Nate Schema penned a letter to OMB. Depending on how the proposal is shaped, he said, the minimum staffing rule could have “devastating consequences” for its senior population living in rural settings.

More than 70% of Good Samaritan’s residents live in rural settings, Schema said. It’s been extraordinarily difficult to find clinical staff for these parts of the country.

“Across our skilled nursing facilities, nearly 1,700 open positions remain unfilled, which means we would need to hire an average of 13 employees in every building to meet current staffing needs. Finding qualified caregivers is difficult in rural areas,” said Schema.

The position of a permanent night shift nurse in Miller, South Dakota, he said, has been open for three years.

Good Samaritan provides services in 139 SNFs across 19 states, Schema said in the letter to OMB.

AHCA was one of the first to meet with the agency regarding the proposed minimum staffing rule on June 14. On the same day, staffing advocates, including National Nurses United and American Federation of Labor & Congress of Industrial Organizations (AFL-CIO), were granted time to speak with members of OMB but there were no documents on the OMB site to indicate what might have been discussed.

AHCA shared a slew of documents with OMB representatives, including a data analysis from CliftonLarsonAllen estimating the industry would need at least 191,000 nurses – and $11.3 billion – to meet 4.1 hours per resident day (HPRD).

A mid-year survey of 425 nursing home providers was another document AHCA shared with OMB, which found that even well into 2023, about 77% of operators say they face moderate to high levels of staffing shortages.

One-third said their overall workforce situation has gotten worse since the end of 2022, according to the AHCA survey.

Representatives with LeadingAge also met with OMB on June 23, according to federal records. LeadingAge detailed the meeting in a blog post a couple days later.

Association leaders focused on potential civil monetary penalties that operators would incur if they failed to meet staffing ratio requirements, and said such fines would detract from care quality.

“What’s more, doing so inequitably harms small, single-site providers,” LeadingAge said in its post. “We reiterated the points we have been making in the ‘Get Real on Ratios’ campaign, including: the need for reimbursement to cover the increased costs; an understanding that ratios will only work with confirmation that there is not a health care staffing shortage in the state or city; and that one size does not fit all.”