The federal government’s solution to resolving quality concerns at nursing homes through minimum staffing standards is weakened by this reality: It’s currently near impossible to bolster the nursing home workforce.

In the weeks since the Centers for Medicare & Medicaid Services (CMS) finalized its staffing rule, the industry has come out swinging with this particular critique, backed by analysis of the havoc such a rule will unleash if implemented, even on a staggered timeline. 

Unless nursing homes can attract workers away from hospitals with more pay, or create more workers, prospects for the staffing mandate don’t look too good, some SNF leaders are suggesting.

“At this time, there are two elephants in the room that must be addressed: a lack of existing health care staff and a lack of the necessary funding investments in nursing home care to be able to compete in the health care labor market,” writes Derek Prince, president and CEO of Texas-based HMG Healthcare, in a column for the Dallas Morning News. “A staffing mandate will not create eligible and qualified direct care staff members who quite simply do not currently exist.”

HMG operates 37 post-acute care facilities in Texas and Kansas.

In quoting statistics for Texas, Prince noted that since 2010, while the number of registered nurses (RNs) in Texas has increased by 42%, only 3% work in long-term care. By comparison, most of these RNs, or about 65%, went to work at hospitals.

The staffing shortage of direct care workers could have been avoidable if the U.S. increased the number of nursing spots to train nurses, Prince suggests. After all, there was no shortage of qualified nurse applicants in 2023, this data showed. Over 13,000 qualified nursing school applications were denied admission simply due to a lack of clinical space or budgeted faculty. 

“In lieu of mandates, we need to invest in the expansion of educational pipelines that incentivize nurses and encourage students to see long-term care as a long-term profession,” Prince notes. “We need to invest additional funding that creates the ability for rural and urban providers alike to compete for the best staff.”

The latest analysis by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) found that the annual cost to meet a minimum staffing mandate could require as much as $6.8 billion per year to hire approximately 102,000 additional nurses.

In the absence of funding to support the mandate and efforts to increase the pool of nurses through more training and educational opportunities, mandates aimed at improving quality of care will be meaningless if there are fewer beds to accommodate the rising tide of SNF residents, Prince said.

“Providers unable to meet staffing mandates would have no choice but to deny new patients, close units or entire facilities, creating access to care issues and further travel for loved ones, particularly in rural communities. Consistent and well-trained staff are critical to providing the level of patient care that nursing home residents need,” Prince writes.