94% of skilled nursing facilities currently fail to meet on at least one metric, prompting warnings about resident access, escalating agency staffing costs, and long-term implementation risks
RN Wages Projected to Grow More Rapidly Than Wages for Other Professions, Study Finds
Among the healthcare professions that were examined for potential wage changes over the next decade — such as RN, physician and dentist — when adjusted for the estimated inflation rate, RN was the only one expected to see growth by $12.82 per hour.
According to the Bureau of Labor Statistics, registered nursing is among the fastest-growing professions in the country, and skilled nursing facilities soon may have a pressing need for such professionals, given the minimum staffing mandate proposed in September by the Centers for Medicare & Medicaid Services.
— McKnight’s Senior Living, October 12, 2023
Staffing Mandate Could Shift Big Costs to States — But They May Not Know It Yet
“If you think about the timelines that you have in an old-fashioned, cost-based system, you’re going to have a period of time where the cost has to be spent to make it into the rate,” Allen told members during a session on Medicaid reimbursement changes. “In a normal environment, you could have a two-to-three-year window to get this included. That isn’t possible. We need to be engaging with the data … and the state reps … to begin advocating for a statewide amendment or perhaps a waiver in order to get this funded prospectively.”
— McKnight’s Long-Term Care News, October 10, 2023
LeadingAge Staffing Mandate Cost Estimate Outpaces AHCA’s; Exec Urges Congress to Act
The proposed federal staffing rule would cost $7.1 billion in the first year alone, according to an analysis from LeadingAge, which sharply criticized the government’s “highly fragmented approach to long-term care financing” in a letter to congressional leaders.
“Federal action on staffing mandates must be realistic to achieve its intended effect and should be paired with historic workforce investments and fair reimbursement rates,” said Katie Smith Sloan, president and CEO of LeadingAge. “The current and highly fragmented approach to long-term care financing no longer serves the millions of residents across the continuum who require compassionate and highly skilled care. Medicaid, the dominant payer of long-term care services, doesn’t fully cover nursing homes’ cost of quality care. Regulations and enforcement, even with the best intentions, just can’t change that math.”
— McKnight’s Long-Term Care News, October 2, 2023
Staffing Rule Could Bring System ‘Collapse,’ Providers Say, But CMS Stands Firm
Nursing homes’ leading lobbying organization unloaded a full, research-backed attack on the viability of the White House’s proposed staffing mandate Tuesday. But the administration was unmoved, and instead doubled down on its commitment to impose first-ever workforce minimums on the beleaguered industry.
American Health Care Association President and CEO Mark Parkinson warned the “whole” US long-term care system would be at risk of “collapse” if the rule were implemented without modifications. Without more funding and other changes, operators would have to restrict services and close wings and buildings, setting off a chain reaction that would discharge more than a quarter million patients out of nursing homes, or roughly 26% of the current population.
— McKnight’s Long-Term Care News, September 27, 2023
Responding to Staffing Agency Profit Misconceptions
As a representative of a nursing agency, we resonate with the growing apprehensions regarding the potentially adverse impacts of the proposed staffing mandate for nursing home operators. We are acutely aware that our partners are already struggling to stay afloat. And we understand that if our customers go out of business, we go out of business, too.
It is critical to delineate a distinction between nursing agencies, which predominantly function as vital allies in healthcare operations, from tech-driven staffing platforms that have engaged in price inflation and monopolistic behaviors. Outside of the tech-based staffing platforms, most staffing agencies are not large enough to influence the labor market. There is so much competition in the staffing industry that most agencies are price takers, not price setters, when it comes to negotiating rates with facilities.
— McKnight’s Long-Term Care News, September 27, 2023
“There are two ways to meet the staffing mandate. One is to increase staff, the other is to decrease the number of residents in the facility. Those are the only two levers that can be pulled,” said Cory Rutledge, chief assurance officer at CLA, speaking at a press conference held by AHCA following the analysis’ release. “Logic would tell us that those individuals don’t have any better options in terms of places to go, particularly those that are on Medicaid.”
— Skilled Nursing News, September 26, 2023
Price of Nursing Home Staffing Mandate Is $6.8B, 100K More Workers, Analysis Finds
That projected cost is nearly 60% higher than the $4 billion annual cost estimated by the Centers for Medicare & Medicaid Services in a draft rule it issued Sept. 1. The CLA analysis was conducted in conjunction with the American Health Care Association/National Center for Assisted Living.
“What CLA’s analysis confirms is that this proposed rule is deeply flawed, and the Biden Administration has woefully underestimated the feasibility and cost of this unfunded mandate,” AHCA President and CEO Mark Parkinson said. “When nearly every nursing home in the country would be considered out of compliance if this went into effect today, it demonstrates how out of touch Washington bureaucrats are with reality. Nursing homes are already grappling with a growing caregiver shortage; to demand they hire 100,000 additional caregivers, without any meaningful resources or support, is a disservice to our nation’s seniors.”
— McKnight’s Long-Term Care News, September 26, 2023
“Based on these figures, nursing homes will need considerable resources to meet the requirements of this mandate, but 60 percent of the profession is currently operating in the red,” said Cory Rutledge, Chief Assurance Officer at CLA. “If this rule is finalized without the financial support that nursing homes will need to hire these additional workers, hundreds of thousands of seniors will be at risk of losing the care they need.”
— American Health Care Association, September 26, 2023
Profiteering by Nursing Agencies Predicted as Providers Weigh Staffing Mandate
“It is not hard to imagine that just as the industry seems to be weaning themselves off of agency, this could very easily force them to reverse course,” Fred Bentley, managing director of consulting firm ATI Advisory, told McKnight’s Long-Term Care News. “How else are nursing home operators going to meet the requirements? I don’t see this massive infusion of more RNs or CNAs coming online.”
— McKnight’s Long-Term Care News, September 11, 2023
Unfunded Staffing Mandate’s Financial Requirements a ‘Fantasy,’ Observers Say
Though a costly national nursing home staffing mandate proposed Friday offers no new financial support for operators, it could trigger more reporting requirements as the federal government tries to spur states into increasing their Medicaid outlays.
“The administration can’t ignore it. They can’t pay for it. They can’t compel states to fund it, and they can’t help find staff. … It can’t happen. This is fantasy, and it upsets me,” Marc Zimmet, CEO of Zimmet Healthcare Services Group and a 35-year veteran of the skilled nursing reimbursement world, told McKnight’s.
— McKnight’s Long-Term Care News, September 5, 2023
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