Nursing Home Challenges To Stir Upcoming Elections as Pennsylvania’s Contentious Senate Race Shows

Nursing home challenges are becoming a hot topic in election debates, most recently with a race in Pennsylvania between incumbent Sen. Bob Casey and his Republican challenger David McCormick.

Industry experts have predicted that nursing homes, along with other settings in long-term care, will be central for future presidential candidates as well. The growth of the older population, along with the projected deficit in the Medicare trust fund and the oldest baby boomers turning 80 in 2026 are just a few reasons for this forecast.

In the meantime, government officials are debating the hottest issue in the industry right now – the federal minimum staffing rule.


McCormick has been critical of Casey’s support of the federal minimum staffing rule, according to an article in the Daily Review, noting workforce shortages, funding issues and accessibility problems long lamented by the industry.

“Casey’s had nearly 18 years to address this growing staffing crisis, and instead applauds an unfunded Biden mandate that will make the problem worse,” McCormick told the Daily Review. “As Pennsylvania’s senator, I will fight to expand skills training for critical careers like nursing and invest in rural healthcare.”

Casey, meanwhile, has said the minimum staffing rule is a critical part of a systemic solution. Seniors in Pennsylvania and around the country have not been getting the high-quality care that they need and deserve, said Casey, and government officials need to do everything to ensure that operators are meeting a high-quality threshold.


“That means investing in the workers who care for our seniors and are currently overworked and underpaid,” said Casey. He was quick to point out that quality care can’t be given without investing in the caregivers who provide it.

Casey introduced the Long-Term Care Workforce Support Act last month, which would increase federal Medicaid funding sent to states. The legislation would also add $100 billion in grants for long-term care and direct care workers, and $500 million annually in grants for workforce training between 2025 and 2029.

When it comes to long-term legislation for the industry, the Biden administration’s reforms provide a glimpse into discussions for the 2028 presidential election. Candidates largely avoided the issue of long-term care prior to Biden, but Biden’s State of the Union address announced the staffing mandate ahead of careful consideration from the Centers for Medicare & Medicaid Services (CMS).

Pennsylvania Sen. John Fetterman endorsed the minimum staffing rule, while three dozen Senate Democrats have opposed it along with Republicans, according to the Daily Review. Naysayers warn the rule could have an adverse impact on rural areas, and that there’s no guarantee that the rule will spark more financial support from government officials.

Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform in Pittsburgh, said rural nursing homes can’t attract staff to work in the area, they can’t afford to pay competitive rates, and on top of that, nursing homes are trying to boost profits by keeping staff levels low.

A mandate should be addressing the third issue, Miller said, but an overreliance on Medicaid means nursing homes in the state can’t pay their staff to adequately recruit or retain them.

“You can mandate that they have staff, but if they can’t afford to pay, then their choice is to go out of business,” Miller told the Daily Review. “The challenge of the staffing mandate is that you have to ensure that you’re not just putting pressure on the facility to do something that it can’t afford to do or can’t find people to do.”

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