CLA Staffing Mandate Analysis — American Health Care Association, December 2022

CliftonLarsonAllen conducted a study on behalf of the American Health Care Association and estimated providers would have to spend an additional $10 billion more per year nationally and hire more than 187,000 new workers to meet requirements of a 4.1 hour standard. Those findings proved that nursing homes would need “substantial and consistent government resources” to comply with the regulations, AHCA leaders said at the time.

Citation: CliftonLarsonAllen. “CLA Staffing Mandate Analysis.” American Health Care Association, Dec. 2022, www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/CLA-Staffing-Mandate-Analysis-Dec2022.pdf. Updated September 2023 | Updated December 2022 | Published July, 2022

As forecast price of federal staffing mandate climbs to $11.7B, analysts offer alternatives

The price tag is going up on a potential federal staffing mandate.

A standard of 4.1 hours per patient per day could cost the skilled nursing sector $11.7 billion annually, according to an updated analysis by consulting and advisory firm CliftonLarsonAllen. That’s up from a projected $11.3 billion in January, and an increase of $1.7 billion in the 13 months since CLA issued its first estimate in mid-2022.

The potential cost has been pushed higher by inflation and continued wage pressures, as the current staffing shortage continues to play out nationwide.

— McKnight’s Long-Term Care News, August 28, 2023

‘Worst Possible Time’: SNF Operators Hope for Acuity Adjustments, Waivers Ahead of Staffing Mandate

As the skilled nursing sector awaits the proposed federal staffing mandate, leading industry operators renewed calls for funding the initiative, and said the Centers for Medicare & Medicaid Services (CMS) should carry it out in phases while also adjusting staffing ratios based on the acuity of the resident populations being served.

“It’s at the worst possible time,” added Almer. “There’s clearly a shortage for staff, and clearly there’s a funding need to support increased staffing … funding is clearly an issue and contributing to the problem.” Existing costs to attract talent are already draining nursing homes while reimbursement levels remain inadequate.

— Skilled Nursing News, June 23, 2023

A loud and clear message on staffing mandates

We’ve heard a lot of chatter about nursing home staffing mandates in the last few months.

In one corner, we’ve got consumers and union reps angry that local ratios for skilled nursing facilities haven’t been enacted or enforced yet. Forget that state officials have backed off the very laws they championed in acknowledgment of the fact that, in some places, there is simply no one to hire.4

Then entering the ring, we had a bipartisan group of senators from mostly rural states call on the Centers for Medicare & Medicaid Services to press pause on its expected proposal to institute nationwide minimums.

The LeadingAge framework asks legislators and other authorities to address longstanding labor and funding issues (some of which CMS can’t address on its own) before ratios are implemented. The six key elements are: Medicaid fee-for-service nursing home rates that cover at least 95% of the cost of care… A certification by Labor and Health and Human Services secretaries that there is no shortage of potential employees qualified to work in long-term care settings. Flexible standards that will meet the current needs of residents.

— McKnight’s Long-Term Care News, January 31, 2023

Defiant Sloan to nursing home critics: Address funding to tackle staffing challenge

The leader of one of the nation’s largest skilled nursing organizations Tuesday pushed back against a recent popular narrative about understaffing, reiterating concerns about Medicaid pay that continues to undercut provider efforts to recruit and retain workers.

“Medicaid is woefully inadequate in every state, doesn’t cover the cost of care, and when you are not covering the cost of care, you’re not enabling the provider to pay their staff what they should be paid,” LeadingAge CEO and President Katie Smith Sloan told McKnight’s Long-Term Care News. “Until we address the funding issue we will continue to be challenged.”

— McKnight’s Long-Term Care News, December 7, 2022

Providers, states grapple with billion-dollar needs ahead of federal staffing minimum

Worries about the cost of a potential nursing home staffing mandate are mounting among provider organizations across the country as more try to pinpoint just how much of an investment they’ll need to meet new requirements.

In Pennsylvania, which has 681 nursing homes, it could cost providers more than $360 million more annually to staff at 4.1 hours per patient day, using calculations modeled on a 4.1-hour staffing rule adopted by Washington, DC, in 2012.

“You’re losing money, you’re losing people but there’s a staffing mandate coming down at the worst time,” Hansen said. “Costs are going up.” … “We can’t conjure workers out of thin air,” Brendan Williams, president of the New Hampshire Health Care Association told McKnight’s Long-Term Care News. “Lacking homegrown licensed staff, in a state with one of the four-lowest unemployment rates, we are maintaining staffing through an untenable reliance on staffing agencies.”

— McKnight’s Long-Term Care News, November 17, 2022