This week, the U.S. House Committee on Energy and Commerce Subcommittee on Health held a hearing titled, “Supporting Access to Long-Term Services and Supports: An Examination of the Impacts of Proposed Regulations on Workforce and Access to Care.” Members of the committee and witnesses during the hearing joined a growing list of voices who are urging the Biden Administration to reconsider its proposed federal staffing mandate for nursing homes.
There is growing consensus that the one-size-fits-all requirement will be impossible for nursing homes to meet, driving facilities to limit their admissions or close down, which will only limit access to care.
See what Members of Congress and long term care advocates are saying about the proposed mandate:
U.S. House Committee on Energy and Commerce Chairwoman Cathy McMorris Rodgers (R-WA-05):
“This minimum staffing rule would set unrealistic staffing threshold. Independent analyses have found that as many as 80 percent of all nursing homes would be unable to meet the requirements of the rule, meaning facilities would have to increase costs for residents, reduce censuses and stop accepting new residents, or potentially even close. We all believe in access to high quality care, but proposed requirements that are untenable for four out of every five nursing homes do not represent a serious solution. And those who rely on skilled nursing care deserve better than a proposal that could dramatically curtail their care. These top-down approaches are not the way forward in supporting seniors and people with disabilities, and it’s my hope that today will begin a conversation on ways to find more meaningful solutions to help those in need.”
“To bring this even closer to home, a local administrator at a Barren County long-term care facility summarized this, stating: ‘Our rural area in southcentral Kentucky simply does not have access to additional workers. The lack of providers that will result from this requirement will result in no options for long-term care services. The Glasgow and Barren County market has five nursing homes and an acute care hospital competing for a small pool of registered nurses … Nursing homes would be forced to stop accepting new patients, as well as cuts to home and community-based services. This would significantly undermine the bipartisan work this committee has undertaken for decades to improve access to care. I call on the Biden Administration to retreat from these misguided policies. I stand ready to work with my colleagues on this subcommittee, state and local officials, patient advocates, and other key stakeholders to comprehensively address these issues.”
“As a small, independent operator who serves residents on Medicaid, we do not have the resources to meet this unfunded mandate. Like much of the profession, Wall Street does not own our company. And we do not have related businesses or ancillary services to help keep us financially afloat. I am terrified this staffing mandate would force us to downsize or shut us down completely, and we would be unable to continue serving seniors in our community. We are not alone in this fear – nearly 300,000 nursing home residents nationwide could be displaced and left scrambling for alternative care if this mandate proceeds.”
“Not only does [the federal staffing mandate] not make sense for diverse geographic areas, it doesn't really even make sense for the workforce because … in practice, the amount that gets passed through even across different populations and programs will differ for the same workforce delivering essentially the same service.”
U.S. Representative Dan Crenshaw (R-TX-02):
“You can create a mandate to create more nurses, it doesn't mean we can write a law that says there'll be 75,000 more nurses, it will not create 75,000 more nurses. It’s just not how laws work. And it's not how nurses work. It's not how a labor market works. They don’t just arrive and there's a strange kind of philosophical assumption with a mandate. It assumes that nursing homes are purposely not hiring nurses. That is the factual assumption being made when you’re offering a mandate. You're saying you are not hiring nurses and you should be.”
“In my district in Washington state and all across the country, we continue to face a severe shortage of health care workers that directly impacts patient care. When nursing homes and long term care facilities don't have the staff or the beds available for patients in need, it leads to long wait times for seniors who then get stuck in hospitals. And then those beds are not available for other patients who might need them. There's a whole cascading effect and so ensuring that we have the workforce that meets the needs of our growing senior population is critical. Now, Washington state already has some of the most expansive staffing requirements of any state. They include some key differences from the [Centers for Medicare and Medicaid Services] CMS proposals and an analysis from the Kaiser Family Foundation found that just under half of Washington nursing facilities, 49 percent, would currently meet the required [registered nurse] RN and nurse aide minimum standard. So, our state is already trying to address some of these concerns around proper staffing levels and adequate patient care and it remains a challenge.”
“We write today to express concern over the Centers for Medicare and Medicaid Services’ (CMS) proposed rule, entitled ‘Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting’ (RIN: 0938-AV25), particularly as it relates to veterans’ access to long-term care. The Rand Corporation estimated 80 percent of the nation's 18 million military veterans will have some need for long-term services. Should this proposed rule move forward, it is imperative that the regulations placed on facilities do not inadvertently lessen aging veterans’ options for care. We recognize the importance of high- quality service, but as drafted and without revisions, this proposal may have unintended consequences that will close nursing homes.”
Nearly 100 U.S. Representatives Sign Bipartisan Letter:
“Instead of moving forward with a regulatory mandate that would exacerbate staffing shortages, the Centers for Medicare and Medicaid Services (CMS) should collaborate and work alongside nursing homes across the country to find innovative solutions to improve the provision of care for seniors and other vulnerable populations. This includes creating apprenticeship programs, like the temporary nurse aide waiver, as well as workforce programs to develop licensed nurses specifically for long term care, to fill gaps in this workforce and provide continued access to care for nursing home residents … We urge you to reconsider your proposal to impose new federal staffing requirements on nursing home facilities, which would adversely hurt their ability to serve existing and prospective residents.”
“I remain committed to supporting access to high quality care for individuals residing in nursing home facilities. However, these proposed requirements could devastate access to long-term care for New Hampshire’s seniors. Instead of burdening nursing homes with new regulations during an ongoing workforce shortage, we should be focused on providing long-term care facilities with the resources and funding to stay open, recruit and retain a strong workforce, and provide residents with the best care possible. Granite Staters, especially those in rural areas, deserve access to long-term care in their communities, and I urge CMS to re-evaluate these regulations to prevent the closure of nursing homes across the country.”
“At a time when nursing homes are already experiencing healthcare worker shortages and financial hardships, CMS and the Biden Administration should not be implementing a regulation that would only exacerbate this issue. If implemented, facilities throughout the country will have no choice but to deny access to our nation’s seniors who need nursing home care, especially in rural communities, like many of the ones I represent in Indiana’s sixth congressional district. This one-size-fits-all regulatory requirement will result in many negative consequences, and I strongly urge Secretary Becerra to reconsider this proposal.”
“There are workforce shortages all across rural America and healthcare workers are no exception. I’m committed to working with my colleagues to find ways to prevent otherwise avoidable closures of nursing homes in Maine.”
“I am again encouraging the administration to reconsider its rule that could force nursing homes in rural Minnesota to close their doors. Further closures of facilities in rural areas would leave seniors with little to no options for care. That is unacceptable. Instead, this letter outlines specific ways CMS can work with stakeholders to improve care and encourage recruitment and retention of qualified staff.”
“The CMS-proposed staffing mandate is not the solution to the ongoing nursing home labor shortage. This mandate may force nursing homes, many of which already operate on tight budgets, to close their doors, reducing access to care. Maine has been grappling with a decline in access to long term care, with 17 facilities shutting down or transitioning to lower levels of care since the start of 2020. The root causes are primarily underfunding and the persistent staffing shortage – both of which will be even more acute should this proposed rule take effect. While nursing homes are eager to hire more staff, the fundamental issue lies in the limited pool of available workers. Implementing an unfunded mandate won't facilitate hiring more staff and will lead to more closures.”
See the growing list of individuals and groups opposed to the federal staffing mandate HERE, HERE, HERE, HERE and HERE.