The Centers for Medicare and Medicaid Services (CMS) plans to offer up to $20 million to boost the registered nurse (RN) workforce in nursing homes, but this, along with the agency’s Nursing Home Staffing Campaign, misses the mark on many levels, according to operators.

This funding grants nursing students seeking to become RNs up to $50,000. Of that amount, a maximum of $40,000 can go towards tuition reimbursement. Also, the nursing students have to commit to work for a qualifying nursing home or state survey agency for a period of three years.

Issued as a Notice of Funding Opportunity (NOFO) available through the Nursing Home Staffing Campaign on Wednesday, the federal agency said this funding is restricted to public and state-controlled institutions of higher education and nonprofits.

“This Notice of Funding Opportunity (NOFO) is focused on helping to recruit Registered Nurses (RNs) to work in nursing homes by offering financial incentives,” CMS said, adding that it is currently accepting applications from organizations who will administer the funds as tuition reimbursement and stipends to RNs. “Nursing home staffing is a critical factor for improving care for nursing home residents,” the agency noted.

CMS acknowledged that nursing homes – and state survey agencies – sometimes struggle to hire enough nursing staff to meet residents’ needs.

In fact, a shortage of staffing has led to not only quality of care concerns, but nursing home closures and a possible crisis of access. Meanwhile, a scarcity of surveyors has resulted in survey delays of three or more years.

For many in the sector, the latest funding round doesn’t even put a dent on the problem.

Aside from the tranche of funding being too little, not making the funding available to a broader swath of clinical workers and excluding for-profit nursing homes from eligibility, is a mistake, ​Steve LaForte, Cascadia Healthcare’s chief legal officer and executive vice president of corporate affairs, told Skilled Nursing News.

‘A Band Aid’

While acknowledging the good intentions behind the proposal, LaForte said its narrow focus on nonprofit facilities, which he said represent only a small fraction of U.S. nursing homes, is disappointing.

“The spirit of doing something is better than the spirit of doing nothing,” LaForte said. “That said, it really feels like putting a band aid on a gaping wound.”

Moreover, focusing solely on RNs ignores the larger staffing needs in nursing homes, he said, because licensed practical nurses (LPNs) and certified nursing assistants (CNAs) form the backbone of the caregiving workforce. 

Funding in the Trump era

At LeadingAge, the largest association of nonprofit nursing homes, the CMS funding initiative was welcomed given a dire shortage of RNs.

However, officials hope that new leadership at CMS will maintain the much-needed funding for staffing, especially if the federal staffing mandate is also kept alive. It is estimated that 20,000 RNs will be needed for nursing homes to meet the staffing mandate in the first full year of implementation, the association said.

“We don’t have a crystal ball to tell us what’s going to happen in the next administration. We would hope the campaign does not go away,” Jodi Eyigor, director of nursing home quality and policy at LeadingAge, said in an emailed statement.

The initial money for this program is part of the $75 million campaign from CMS, while the expected total for the RN-incentive program is $80,000,000, Eyigor noted.

“This amount obviously exceeds the previously announced $75 million and does not consider the costs of other parts of the nurse staffing campaign previously announced by CMS, such as efforts to increase nurse aide staffing by collaborating with and increasing awareness of state training programs,” she said. “We are reaching out to CMS for clarification on where the additional funding is coming from.”

All said, it should be noted that the money is not tied to the staffing mandate, and should be in place regardless of the federal staffing mandate’s ultimate fate.

CMPs Link Concerning

Still, this round of funding – and the larger staffing campaign – leaves many in the sector dissatisfied.

“We appreciate that CMS is finally sharing some details about this campaign that was announced more than two years ago; however, we are concerned about some of the fine print on these funds. Limiting the eligibility to only RNs fails to recognize the immense value of LPNs to the long-term care profession. We are also concerned that it will take months and even years to distribute these funds to registered nurses,” Holly Harmon, senior vice president of quality, regulatory and clinical services at the American Health Care Association and Center for Assisted Living (AHCA/NCAL), the largest association of for-profit providers. 

Of prime concern for Harmon is the fact that CMS has designed the staffing campaign to be funded by civil monetary penalty (CMP) fines to pay for RN surveyors.

“This reduces resources for recruiting more RNs who would provide direct care to residents in nursing homes,” she said, adding, “Finally, we are troubled that the exclusions for the Financial Incentive Administrator eligibility limits the campaign’s reach from organizations that are already connected to the nursing homes and the RNs who need it most.”

And rather than piecemeal solutions, LaForte said he is advocating for a comprehensive, long-term workforce strategy that allows all the players across the health care continuum – from nonprofit and for-profit nursing home operators to health care associations and even hospitals – a seat at the table.

More details on the financial incentive program can be found at https://grants.gov/search-results-detail/357885.