AHCA CEO: Nursing Home Policy Nightmare Just Starting, Business Nightmare Persists — But Clinical Nightmare Over

The “clinical nightmare” created by Covid-19 has come to an end, but the “business nightmare” related to the pandemic is ongoing, and the “policy nightmare” has only just begun.

That’s according to Mark Parkinson, CEO and president of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), the largest nursing home provider association in the United States.

“What’s keeping me up right now is the policy nightmare,” Parkinson said Monday at the AHCA/NCAL Annual Convention and Expo, taking place in Denver. “ … The proposed staffing rule is an overreaction — a poor reaction to a horrible crisis that we all experienced.”


He reiterated objections that he has raised repeatedly — including at the Skilled Nursing News RETHINK conference — since the Centers for Medicare & Medicaid Services (CMS) first proposed the staffing mandate about one month ago. Specifically, he said that the requirement is impossible to implement due to lack of available workers and lack of funding.

With regard to the lack of workers, he pointed out that the nursing home sector lost 244,600 jobs between Feb. 2020 and April 2022, while only regaining 86,100 through Aug. 2023.

“The thought that we could somehow replace these 150,000 people and then hire another 100,000 nurses is just ridiculous,” Parkinson said in his address at the AHCA conference.


Furthermore, CMS estimates that the mandate would cost $4 billion to implement, and a study commissioned by AHCA put the cost at about $6 billion.

“In the unlikely event that we could somehow find these workers, there is just no way to pay for it,” given that the federal government has not meaningfully stepped up funding, Parkinson said. He also described the proposed penalties for noncompliance as too large, the potential waivers for providers as “too hard to get,” and he said that the rule “deeply disrespected” licensed practical nurses.

Still, he is optimistic about the nursing home industry’s ability to influence the proposal during the current 60-day comment period. Parkinson highlighted several recent examples of successful advocacy, including on the issue of vaccine mandates for health care workers.

“You may not remember this, but when it was first announced, it was only for skilled nurses; hospitals started running ads saying, hey, if you’re going to be forced to be vaccinated in skilled nursing homes, come work for us,” he said. “Within five days, we generated 5,000 emails, and I got a call from the White House where the words were, ‘Your members have changed our mind.’”

Similarly large outpourings from providers helped reverse proposed Medicare cuts and ease a “very difficult” masking standard from the Centers for Disease Control & Prevention (CDC), Parkinson noted.

“We need your help one more time,” he said. “I have a strong belief that we will get it — people have already stepped up. We’ve received thousands of comments.”

By this time next year, the industry could be “well on the way” to saying that the policy nightmare is over, just as providers today can say that the clinical nightmare of Covid-19 is over, he emphasized.

With regard to the end of the clinical nightmare, Parkinson shared a chart showing trends in Covid-19 infections in nursing homes, illustrating that even as infection rates have fluctuated, the number of deaths has been consistently low since the advent of Covid-19 vaccines.

While continued vigilance is required, the history of pandemics also provides reason to be hopeful, as viruses have tended to become less dangerous over time, he noted.

“I think that we can safely say that we have beaten this thing,” he said.

He also struck an optimistic note with regard to the business nightmare stemming from Covid-19. Occupancy has recovered slowly since the low point of 67.5% in 2020, but Parkinson thinks that the industry will likely regain pre-pandemic occupancy levels within the next year, with census continuing to slowly build over the next three to five years.

Workforce challenges remain more concerning, but the trends are moving in the right direction in terms of regaining pre-pandemic staffing levels.

“I’m hopeful that within a year, we’ll be back almost to normal, and we can say the business nightmare is over — but it’s not quite over yet,” he said.

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