In case you missed it, the American Hospital Association (AHA) sent letters to Members of Congress in support of legislation that would overturn the Centers for Medicare & Medicaid Services’ (CMS) one-size-fits-all federal staffing mandate for nursing homes. The letter states:
“[The] process of safely staffing any health care facility is about much more than achieving an arbitrary number set by regulation. It requires clinical judgment and flexibility to account for patient needs, facility characteristics and the expertise and experience of the care team. The Centers for Medicare & Medicaid Services’ (CMS) one-size-fits-all minimum staffing rule for LTC facilities creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements."
The association representing our nation’s hospitals cited concerns over the ripple effects the staffing requirements would have throughout our entire health care system, specifically overstraining hospitals:
“The AHA also is concerned that this final rule could lead nursing homes to reduce capacity or close outright, including those that are otherwise performing well on quality and safety metrics. The loss of these nursing home beds could adversely impact patients who have completed their hospital treatment and need continuing care in nursing facilities.”
Recent articles in Skilled Nursing News and McKnight’s Long-Term Care News reported on the impacts that the long term care workforce crisis has on hospitals and their patients. When a nursing home is unable to take in new residents because of labor shortages, hospitals that are ready to discharge a patient in need of post-acute care are forced to keep these patients, further straining the hospital system.
The articles highlight comments from Anne Tumlinson, CEO and founder of ATI Advisory, during a recent webinar discussing the workforce crisis. Tumlinson said:
“We see an increase in the length of stay across all of these discharge destinations, but the average length of stay on the whole is the highest for the skilled nursing facilities… So we’re definitely seeing that the labor that the skilled nursing facilities rely on to operate to be able to admit patients has become a real challenge, and a big part of the reason why we’re seeing people boarding inside hospitals.”
ATI Advisory found that in the second quarter of 2023, 43 percent of hospital patients who had to wait 30 or more days for their discharge were placed in skilled nursing facilities.
Further, the staffing mandate threatens to force a variety of health care industries to compete with one another for caregivers in an already limited labor pool, ultimately leaving patients with restricted access to care. This week, representatives of home health companies argued that the rule could exacerbate staffing shortages in that industry, with both professions vying for the same talent. A recent story in Modern Healthcare highlighted the home health industry’s concerns, articulated by William Dombi, president of the National Association of Home Care and Hospice:
“…companies offering home health services worry the nursing home staffing mandate — which will require skilled nursing facilities to hire thousands of additional registered nurses and nurse aides — will make it even harder for them to recruit enough workers to meet rising demand. It’s a pretty simple calculation. If there is a limited supply of nurses and nurses aides, it will affect home care when one other sector in healthcare has increased needs for more staff.”
The executive director of the National Center for Assisted Living (NCAL), LaShuan Bethea, and other senior living organizations raised similar concerns for assisted living providers in recent months. According to an analysis from the American Health Care Association (AHCA), the unfunded staffing mandate requires nursing homes to hire 102,000 additional nurses and nurse aides in order to comply, despite a growing caregiver shortage.
Rather than blanket mandates that will reduce access to care and strain the entire health care system, policymakers need to focus on innovative policies and investments. AHCA/NCAL has been advocating for a comprehensive approach to grow the long term care workforce and improve quality care for years. We will continue to push against misguided actions, like the federal staffing mandate, and fight for more meaningful solutions.