Industry leaders continued to have mixed reactions about the fate of the Biden Administration’s nursing home staffing mandate after the accidental online release of a staffing study commissioned by the Centers for Medicare & Medicaid Services (CMS), with some insiders questioning the leaked study’s data.

Industry stakeholders doubted the reliability of the study conducted by Abt Associates.

“Abt Associates sourced data from several SNF domains in their analysis,” Marc Zimmet, CEO of Zimmet Healthcare Services, told Skilled Nursing News (SNN).  “These source documents are flawed, outdated, inconsistent, and inaccurate to begin with.  When cross-contextualized, outcomes are effectively arbitrary.”

The study explored staffing thresholds below the ones previously considered optimal in a federal assessment. Researchers also indicated that no solitary staffing measure could ensure high-quality care – a stance which many leaders in the skilled nursing industry, mired with a staffing crisis, have long endorsed. Yet, the study concluded that increased staffing levels would lead to reduced hospitalizations, faster care delivery, and decreased instances of care omission.

And while there is no clarity on the details of the proposed staffing regulation, one thing remains clear—staffing shortages and the necessity to adapt and thrive in such conditions are paramount challenges facing the industry.

Lee Teslik, CEO of Reverence, told SNN that as the industry looks ahead to the next 10 to 15 years, it’s foreseeable that the industry will oscillate between periods of tight staffing environments and full-blown staffing crises. 

“In a nutshell, I would very much agree with a lot of the leaders in the skilled nursing industry that the wrong policy moves here hold the potential to make what’s already a bad staffing situation worse and not better,” he said. “And I think the study that was leaked basically reinforces that. There isn’t, you know, a single staffing measure that would by itself, you know, ensure high-quality care.”

Staffing thresholds

Teslik said that regardless of the mandate, the industry is going to have to get creative in order to thrive within the current environment.

“If you look at the age demographics of the existing nursing workforce, a large percentage will be retiring in the next 10 years, so that doesn’t help. And frankly, there aren’t enough new people coming into the industry to cover the gap,” he said.

The situation, he said, arises from a convergence of factors, including well-documented demographic shifts and the impending retirement of a substantial portion of the existing workforce.

“Skilled nursing leaders are going to have to do more to figure out more sustainable, more flexible staffing models that enable them to do more with less, and that enable them to maintain quality,” he said.

Doing more with less

Teslik said that ‘doing more with less’ is already happening for a lot of leaders – many of whom are dismantling staffing silos and promoting collaboration across facilities, allowing for fluid deployment of workers and reducing reliance on third-party staffing agencies.

“Some of the larger players are going the direction of full-on internal staffing agencies, creating separate business units that can support their staffing first but can also sell separately into the broader market and is a sort of alternate source of revenue,” he said.

He added that the industry is seeing a lot of interesting opportunities for operationalizing, through automizing ‘brute force operations work.’

“It’s enabling schedulers to do the work that they’re doing in less time and often with better results,” he said.

Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services, told Skilled Nursing News that the research findings released yesterday made it clear that a one-size-fits-all approach to staffing mandates won’t work.

“And now it seems that the Office of Management and Budget canceled its remaining meetings with stakeholders,” she said.

She said that LeadingAge hopes the Biden Administration will acknowledge that there are too few people to hire and that the costs of delivering quality care far exceeds reimbursement.

“Staffing ratios are not the answer. CMS needs a new approach to achieving consistent, quality care in nursing homes—and it must begin with meaningful solutions to the workforce crisis,” she said.