As the federal government’s new staffing mandate looms large for nursing homes, operators are grappling with challenges in meeting the upcoming facility assessment requirements but urge compliance despite the burdens on staff.

Stuart Almer, an industry veteran who is also president and CEO of Gurwin Healthcare System in New York, highlighted the daunting nature of the federal government’s staffing mandate – and its accompanying requirements – during a recent panel discussion led by Skilled Nursing News titled, “Mandate and Margin: Skilled Nursing CEOs on Rethinking Staffing, Payments, & Strategic Business Imperatives.”  

In New York, which has been dealing with a staffing mandate for a couple of years, Almer said the mandate’s requirements have certainly created burdens. 

“Reading the data, only 6% of skilled nursing facilities may be able to meet requirements of the new facility assessment. So clearly, that’s telling all of us that there’s a problem,” Almer said. “We’re all doing many things to recruit to retain staff, but the numbers are concerning.”

Nationwide, the mandate would necessitate hiring an estimated 102,000 nurses and certified nurse aides, requiring approximately $6.5 billion in funding – data that points to the shortage of nurses currently, which will only make conducting the facility assessments difficult.

The staffing mandate will likely negatively impact already strained facilities, according to Erin Shvetzoff Hennessey, CEO of Health Dimensions Group, or HDG.

Despite the challenges, Hennessey said it was imperative to comply with the upcoming facility assessment requirements, effective August 8, and prepare facilities for inevitable state surveys come October.

“This first step is making sure that your facility assessment is updated, and it is a lot of work for providers who are already understaffed. You’re adding more work to a group that already is balancing a wide variety of things,” Hennessey said, noting all the operational burdens faced by SNFs. 

Cooperating with facility assessments is about bigger things, however, she said. 

‘See where the gaps are’

“We need to continue at a larger level, as an organization, as a trade, to really understand those assessments, and see where the gaps are,” Hennessey said.

“So our guidance to our clients and in our own communities is [going forth in] doing these assessments. We’re going to be ready for a survey when they come in October, right? We’re going to make sure that we’re ready. We have all the information done,” she said. “Agree with [the staffing mandate], disagree with it. It may not happen, it may be overturned, but just do the [facility assessments]. We’ll know where we’re at.” 

As SNFs nationwide brace for the August deadline, preparations are underway across the board. The industry is mobilizing resources to prepare leadership.

HDG is bringing all of its teams together for an operational summit, and has dedicated whole sessions on facility assessments for executive directors and directors of nursing in order to make sure they’re fully prepared, Hennessey said. 

“So a lot of work … but least you have a place to start,” Hennessey said.

The federal mandate’s initial requirement involves conducting updated facility assessments to comprehensively evaluate staffing needs, factoring in resident-specific care requirements and input from residents, families, and external stakeholders. This process aims to ensure that SNFs can adequately meet the diverse care needs of their residents, including those related to behavioral health—a component often overlooked in previous assessments.

‘Lack of clear guidance’

However, both Almer and Hennessey pointed out significant hurdles in implementing these assessments effectively. 

“There’s a lack of clear guidance,” Almer said, stressing the need for standardized frameworks to streamline the assessment process.

“And once we have more guidance, it will be easier for us. But right now, we have to adjust, and we’re being required to adjust and take all this into consideration when there’s still overall a lack of available, qualified staff,” Almer said.

Moreover, the operational impact of non-compliance has already surfaced in state surveys, Almer said with facilities facing citations for staffing deficiencies.

Almer also expressed fears about potential penalties down the road, exacerbating financial strains.

“Facilities are being cited for lack of staff, and it’s a challenge,” he said.

Industry leaders also advocated for government funding to bolster staffing efforts.

Almer proposed more funding and collaborations with educational institutions to cultivate a qualified workforce pipeline—a proactive measure aimed at addressing long-term staffing shortages and fostering sustainable staffing solutions.

“Incentivizing staffing initiatives is crucial,” Almer said, who said operators are bearing the costs of improving the size of the nursing home workforce.

Eventually these efforts will play a key role in bolstering SNFs’ capacity to meet federal standards and ensure quality care delivery, Almer said. At the very least, facilities must not have to bear penalties when they are trying hard to fulfill staffing requirements.

In New York, for the state level mandate, penalties have as yet to follow, but operators are worried.

“I’m concerned because that will just make the financial situation tougher for everyone, while we are working very hard to improve things. I think if someone was to look overall, things are getting better for all of us. Everyone’s working hard to make it better,” Almer said.