Nursing Home Leaders Support House Bill To Defeat CMS’ ‘Cookie-Cutter’ Minimum Staffing Proposal

A Congressional bill that aims to defeat the Biden Administration’s minimum staffing proposal began making rounds last week, and nursing home executives, including clinical team members attending the industry’s largest annual gathering in Denver, hailed it as a welcome development.

If passed, the bill could keep the Centers for Medicare & Medicaid Services (CMS) from implementing the proposed rule.

“It has never been proven that cookie-cutter approaches help seniors. A blanket mandate has usually not worked so I’m very skeptical of the staffing mandate, personally,” Dr. Arif Nazir, who serves as chief medical officer for the physician group Abode Care Partners, told Skilled Nursing News.

Rep. Michelle Fischbach (R-Minn.), who introduced Protecting Rural Seniors’ Access to Care Act, said she had opposed the proposed federal staffing mandate right from the onset, particularly in light of the federal government’s own report questioning the effectiveness of such a mandate.

“I am deeply disappointed CMS continued to move forward with this rule given the public knows their reservations regarding its efficacy. If the one-size-fits-all staffing ratios issued by CMS are put in place, it will devastate facilities across greater Minnesota, forcing them to either decrease the number of patients they serve even further, or close their doors entirely,” Rep. Fischbach said in a press release.

CMS issued a proposal on Sept. 1 that calls for Medicare- and Medicaid-certified nursing homes to provide a staffing equivalent of 3 hours per resident per day (PRPD), with 0.55 hours of care from registered nurses (RNs) and 2.45 hours of care from certified nursing assistants (CNAs). Non-rural nursing homes will have 3 years and rural nursing homes have 5 years to meet these standards. The rule also calls for facilities to have an RN on staff 24 hours a day, daily.

“I get the need for it, and I’m one of the biggest supporters of CNAs and our nursing teams,” Nazir said. But, he added, “Coming up with a blanket mandate that may result in unnecessary fines and closures of nursing homes is going to create a disaster, in my opinion.” Nazir is also affiliated with Signature HealthCARE and American Senior Communities as a consultant.

Nursing home advocacy groups support the bill, pointing to a shortage of labor, with the costs of labor still among the biggest challenges confronting the sector.

“Rural and underserved communities already face a crisis in access to care, and CMS’s troublesome mandate would only make it harder for older adults and families in these communities–and across the country–to get the care they need. Getting this wrong will undercut equity and access in care across the aging services spectrum,” said Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services. “LeadingAge wholly supports this bill and will encourage our advocates to urge their representatives to do the same.”

Meanwhile, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) said in an emailed statement to SNN, “We fully support this bill and look forward to advocating for its passage,” AHCA/NCAL said in an emailed statement.

In lauding the bill, AHCA/NCAL criticized the inadequacy of funding in the proposed staffing mandate, and noted a recent study the association commissioned from CliftonLarsonAllen (CLA), which estimates that the staffing proposal would require $6.8 billion each year to hire 100,000 additional caregivers.

“This impossible standard only threatens to shut down more nursing homes and limit access … Rather than a mandate, we need thoughtful workforce policies that will help address nationwide nursing shortages, attract more caregivers to the profession, and support care professionals in developing a career in long term care,” the AHCA/NCAL statement read.

Congressman Greg Pence (R-Ind.), who co-sponsored the bill, also noted the staffing constraints facing nursing homes in Indiana. “If implemented, this will result in limited access to care for seniors, mandatory increases in state Medicaid budgets, and could lead to nursing home closures, which would have an especially negative impact in rural communities, like many of the ones I represent in Indiana, that already experience health care access challenges.”