According to a recent analysis from the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), the rule would require an additional 102,000 nurses and nurse aides at a cost of $6.5 billion each year. Nursing homes, which are already struggling to find qualified caregivers, would not be able to meet this impossible mandate, leading to more facilities having to limit admissions or closing permanently. It’s estimated that 290,000 seniors could be displaced under the new mandate.
Proponents argue that the mandate is necessary and will improve quality care, but a look at the data and facts proves otherwise.
MYTH: This staffing mandate is necessary given what happened in nursing homes during the pandemic.
FACTS:
- Despite constant pleas for help and resources during the pandemic, nursing homes were largely ignored by public health officials, and long term care residents and staff were not made the highest priority.
- According to the Centers for Disease Control and Prevention (CDC), COVID-19 uniquely targeted the elderly and those with underlying conditions, making nursing home residents the most vulnerable population. More than 81 percent of COVID-19 deaths have occurred among those over 65 years old.
- Every congregate setting around the world struggled to keep COVID-19 at bay, and independent research found that COVID outbreaks in U.S. nursing homes occurred because of high spread in the surrounding community.
- In the decade prior to the pandemic, nursing homes were making demonstrable progress in improving care and nursing staff were spending more time with residents than ever before. Federal policymakers should promote collaborative efforts with providers rather than issue blanket mandates.
MYTH: Nursing homes are not doing enough to recruit more staff or invest in their workforce.
FACTS:
- According to AHCA’s recent State of the Sector Report, 99 percent of nursing homes currently have open jobs and are actively recruiting caregivers. Nearly 95 percent say it is somewhat or extremely difficult to recruit new staff.
- The survey also found that 90 percent of nursing homes have increased wages to invest in their workforce.
- Nursing homes are doing everything they can to recruit and retain new staff, but without the available labor force and funding, it will be impossible for nursing homes to meet the staffing mandate.
MYTH: There is not a shortage of caregivers; there is a shortage of good jobs. A staffing mandate will prevent caregiver burnout.
FACTS:
- The entire healthcare system, but particularly, the long term care profession, is experiencing a worker shortage. The nursing home workforce is still down 7.3 percent compared to the beginning of the pandemic and needs more than 116,000 workers to recover.
- The nation’s caregiver shortage is only going to get worse. The country may experience a shortage of registered nurses (RNs) between 200,000 and 450,000 by 2025. By 2027, almost 900,000—or almost one-fifth of RNs—intend to leave the workforce.
- The elderly population is on the rise, contributing to the growing caregiver shortage. The U.S. Census Bureau estimates that Americans aged 65 and older will make up more than 20 percent of the population by 2030. That means that the number of job openings will only continue to increase.
- The mandate will likely accelerate burnout and turnover. When nursing homes can’t find additional workers, current caregivers may have to work longer shifts or overtime to comply with the arbitrary staffing requirements.
MYTH: Staffing minimums will ensure quality care for seniors.
FACTS:
- A study commissioned by the Centers for Medicare & Medicaid Services (CMS) revealed there is no single staffing level that would guarantee quality care within nursing homes.
- There may be unintended consequences on nursing home residents as a result of this mandate, a concern CMS raised during the Obama Administration. Facilities may be forced to rely more on costly staffing agencies. Agency staff are associated with poorer quality care, as they are not as familiar with the facility, staff, and residents.
- Each resident is unique, and a one-size-fits-all staffing mandate ignores more modern staffing approaches. As the American Hospital Association articulated, “[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 staffing mandate hurts seniors in the long run because ultimately, it will reduce their access to care. Nearly one-quarter of nursing home residents may be at risk for displacement, as facilities are forced to reduce their census in order to comply with the mandate, or ultimately close altogether. Disruptions in long term care are detrimental to the health and wellbeing of nursing home residents.
- Delays in care can also lead to negative outcomes. Countless seniors will be forced to wait in hospital beds for the post-acute care they need because they can’t find a place at a skilled nursing facility to continue their recovery.
MYTH: Facilities have two to three years before the mandate goes into effect. That is plenty of time to hire caregivers and adjust.
FACT:
- Nursing homes are still rebuilding their historic workforce losses due to the pandemic. At the current pace, the nursing home workforce will not even return to pre-pandemic levels until 2026. Workforce shortages existed pre-pandemic so even returning to those levels will not be enough to meet the mandate. Two to three years is not nearly enough time for facilities to find and hire the thousands of additional workers needed to meet the mandate, especially without any resources or workforce development programs.
- In the coming years, the caregiver shortage is only anticipated to grow. As the population ages, there will be fewer younger people to help take care of our nation’s seniors. Staffing minimums are a 20th Century solution for a 21st Century problem and do not make sense given these changing demographics.
MYTH: The new staffing requirements are reasonable, but if facilities cannot meet them, they can get an exemption or a waiver.
FACTS:
- Implementing a mandate that the vast majority of nursing homes cannot currently meet is poor public policy, or as one Medicare expert said, “the definition of policy insanity.”
- Only six percent of facilities currently meet all four requirements of the mandate, underscoring how unrealistic these new standards are. Four out of five facilities cannot meet the 24/7 RN requirement, while half of facilities cannot meet the 0.55 RN hours per resident day (HPRD) requirement, and 70 percent cannot meet the 2.45 nurse aide HPRD requirement.
- The burden is even greater for rural facilities, where qualified caregivers are already scarce. Ninety-two percent of rural facilities will have to hire more nurses to fulfill the RN requirement.
- These so-called “exemptions” will be virtually impossible for many facilities to meet due to the extensive criteria. CMS estimates that only 25 percent of facilities may qualify.
- For instance, the 24/7 RN waiver is impossible for urban facilities to attain.
- Much of the process to receive exemptions is cumbersome with arbitrary requirements that force facilities to undertake multiple, penalizing steps just to demonstrate they can’t find workers. For example, facilities cannot request these exemptions; it must come up during survey, which means a facility must be cited without ever having the chance to even ask for an exemption.
- Ultimately, without a viable path for many facilities to attain an exemption or waiver, they will be forced to downsize or close—reducing seniors’ access to care.