Thousands of Nursing Home Leaders Pen Letter to Congress, Again Urging Rejection of Federal Staffing Proposal

More than 1,000 nursing home leaders, along with associations like LeadingAge and the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), sent a joint letter to House Ways and Means Committee leaders to reject the federal minimum staffing proposal.

The letter, spearheaded by AHCA/NCAL, was sent late Thursday and signed by state partners and providers as well, urging support for the Protecting Rural Seniors’ Access to Care Act (H.R. 5796) which would effectively stop the proposal. The legislation was first introduced by Reps. Michelle Fischbach (R-MN) and Greg Pence (R-IN). There’s a companion bill in the Senate. All told, there are 11 members of Congress working to push the legislation forward.

“Nursing homes are a critical part of our health care continuum, which is why the number of stakeholders speaking out against this flawed policy continues to grow,” AHCA/NCAL Senior Vice President of Government Affairs Clif Porter said in a statement. “We are extremely proud to have led this effort and grateful for the support of these organizations.”


The association strongly urged Congress to support the legislation, and in turn protect access to care for the country’s seniors.

Prior to the legislation, 28 Senators themselves sent a letter to Centers for Medicare & Medicaid Services (CMS) urging the agency to stop the proposal, especially given a study at the time found that staffing levels don’t necessarily guarantee quality of care provided in nursing homes.

Since the federal staffing proposal was announced, there has been a growing consensus among members of Congress – on both sides of the aisle – that the proposal would hurt residents and their families, nursing home leaders said in the letter. These same members of Congress said the Biden administration should reconsider its implementation.


“Our estimates reveal a staggering $7.1B price tag in the first year alone, far beyond CMS projections,” said Katie Smith Sloan, president and CEO of LeadingAge. “Nursing homes cannot bear the burden of those costs alone. What’s more, the mandate would require tens of thousands of additional workers—and there are simply not enough people to hire.”

Besides stopping the staffing proposal, legislation would also establish an advisory panel on nursing home staffing with voices from urban and rural communities, those that serve as nurses and licensed administrators, as well as officials from CMS.

The panel would, within 60 days of convening, submit a report to Congress analyzing workforce shortages and make recommendations to strengthen the staffing pipeline, including investments in training for health professionals.

Rejecting CMS’s staffing proposal is crucial, she said, to safeguarding access to care and preventing further nursing home closures. The proposal as it stands is unfeasible, while the financial burden it imposes threatens nursing homes already strained by chronic Medicaid underfunding.

“This mandate will neither improve care nor address the workforce crisis,” the leaders stated in the letter, adding that the proposal sets an “impossible standard.”

Nearly 300,000 nursing home residents run the risk of displacement, should the proposal be finalized as is, leaders said in the letter.

The industry sorely needs workforce development programs and funding, rather than a staffing mandate, according to the letter – this messaging runs in tandem with what the Office of the Inspector General (OIG) recommended to CMS in a report that was published that same day.

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