Biden Criticized for ‘Inaccurate Framing’ of Sector By Nursing Home Groups as Staffing Rule Discussion Heats up in Mainstream Media

Nursing home advocacy groups criticized the Biden Administration for “misleading” the public with its negative rhetoric on nursing homes as reactions to the federal government’s minimum staffing rule continued to trickle in.

Discussions of the finalized staffing rule were seen in recent policymaker committees, including the U.S. House Energy and Commerce Subcommittee on Health, and in national media outlets like Forbes and NPR. Meanwhile, LeadingAge penned a letter to President Biden, urging the administration to partner with the industry rather than disparage operators.

Commentary ranged from “extreme concern” over the finalization of the rule on the part of lawmakers to pleas for solutions and collaboration with the industry. Still others weighed the long lead time for the rule against upcoming elections.


In her letter to President Biden, LeadingAge President and CEO Katie Smith Sloan called out the mischaracterization of aging services providers and repeated incendiary descriptions of nursing home care that marked the White House’s messaging related to the finalized rule.

“To be clear: bad actors must be stopped—and, as you know, nursing homes must follow federal and state requirements to protect residents’ health and safety and to ensure the proper use of funds derived from taxpayer dollars,” Smith Sloan wrote.

But, this is no time to mislead the public and discourage potential employees from joining the industry, she said.


“Your administration’s inaccurate framing of all providers and our sector threatens to undermine efforts — including the $75 million recruitment campaign promised by CMS to encourage more nurses to work in nursing homes — to achieve the shared goal of bringing new staff to the field,” said Smith Sloan.

Meanwhile, on NPR’s All Things Considered, President and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) Mark Parkinson said the Biden administration has done nothing to help the industry with the nursing shortage. The requirement to hire an additional 120,000 nurses as well feels impossible, he said.

“Every nursing home in the country is out there right now hustling and advertising to get more staff. But what we are against is an impossible policy that when it is enforced will cause hundreds and possibly thousands of nursing homes to close,” Parkinson told NPR.

In the end, the multi-year run time of the federal nursing home staffing rule may work against it, especially if President Biden isn’t elected for a second term, experts said. And in the event that Donald Trump is elected in November, it wouldn’t be surprising if repealed the rule, Howard Gleckman wrote in a Forbes article.

“Biden’s new staffing rules are ambitious but it will be many years before we know if they are successful,” said Gleckman.

Moreover, Gleckman suggested that the fine print of the federal nursing home staffing rule appears to acknowledge the ongoing workforce shortage among multiple health care settings, with a general two-year lead time to meet the combined 3.48 staffing standard.

Rural facilities get three years to meet the standard, and operators overall will be given one more year – until 2027 – before they need to meet the breakdown of registered nurses and aides within the standard. For rural facilities, that’s a total of five years to meet all standards.

CMS also baked in waivers to the rule, specifically for the 24/7 RN rule; operators can also request temporary exemptions if unable to comply with certain aspects of the rule due to the workforce shortage.

Some solutions to shortages fall to operators, Gleckman said, pointing to raising wages and improving working conditions. Other issues are outside operators’ control, such as strict immigration laws, along with a growing aversion among clinical workers to taking on “increasingly dangerous direct care work,” Gleckman said.

Funding may encourage states to provide financial incentives for prospective nurses and make it easier for nurse aides to enroll in training programs, and then land nursing home jobs. However, nursing home advocacy groups have deemed the $75 million in federal funds set aside for recruiting, training and tuition for nurses as being insufficient.

Policymakers including Brett Gurthrie (R-KY-02) are “extremely concerned” about the rule threatening access to long-term care services. Guthrie serves as chairman of the Energy and Commerce Subcommittee.

“While I agree that we need to do more to ensure our frontline caregivers and clinical care providers are compensated commensurately with the care they’re providing and offer a better quality of life for our most vulnerable, this approach simply won’t work,” Guthrie said in a statement.

The rule was finalized despite more than 500 nursing homes closing since the start of the pandemic, and the industry having 150,000 fewer long term care workers compared to pre-pandemic numbers, Guthrie wrote.

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