SNF operators monitoring PBJ compliance and Five-Star staffing ratings should use current payroll data now to model gaps against the proposed 0.55 RN HPRD and 2.45 CNA HPRD thresholds, as fewer than 20% of nursing homes currently meet the 24/7 RN requirement.
If a nursing home can provide exceptional care at a staffing level below the required minimum level, why should they be forced to hire extra staff? The problem with minimum staffing levels is that many operators will try to hit that target and then call that good enough regardless of whether residents are actually getting the care they deserve and need. Higher staffing does not automatically mean better care.
— Senior Living Foresight, November 8, 2023
Moving Forward Coalition Members Discuss Nursing Home Staffing Issues, Action Plans
“If lots of people are saying, ‘we simply cannot find workers, we would hire them if we could’ – that is a signal. That is not noise, that is a signal, and it’s a strong signal. We have got to fix that,” Bonner told SNN. “We want to bring together all the organizations, all the programs, all the apprenticeships, and then together figure out what would help a state like Montana or an inner city in New York City or Newark, what would help any of those places to be able to find staff.”
— Skilled Nursing News, October 31, 2023
Trilogy, Avamere, Ignite Execs: Mandate Would Require New Staffing Incentives, Worsen Wage Pressure
With nursing home operators having a couple months to process the minimum staffing proposal, many are taking a hard look at what would need to change to meet the proposal in its current form, and what revisions would make the most sense.
“Although it’s a three year phase-in in the state of Oregon, the Oregon Center for Nursing and the Oregon State Board of Nursing is anticipating anywhere from [a] 4.3 to 5.7 year recovery time … there’s not going to be enough nurses if recovery takes five years or more in the state of Oregon,” said Tabor. Avamere has increased wages for its nurses by 46% over the last four years; Tabor expects the minimum staffing proposal to continue to drive that up, if finalized.
— Skilled Nursing News, October 27, 2023
The proposed federal staffing mandate is a potential “kill factor” for nursing home providers, while the rise of Medicare Advantage (MA) is a “major challenge” — and how well the sector responds to these threats will play a major part in shaping the future.
This is the perspective of Phil Fogg Jr., CEO of Marquis Companies and the immediate past chairman of the American Health Care Association (AHCA). He took to the stage Wednesday for the skilled nursing keynote session at the National Investment Center for Seniors Housing & Care (NIC) Fall Conference in Chicago.
“When you have federal mandates without any association to the reimbursement … it changes the economics in a way that can absolutely kill you.” Fogg believes that nursing homes in rural and semi-rural markets could disappear if the mandate goes through, and that scrapping the staffing rule may be necessary but might not be sufficient.
— Skilled Nursing News, October 25, 2023
Parkinson Says Proposed Staffing Mandate a ‘Death Sentence’ for Rural Nursing Homes, Offers Answers
But the increased potential to collaborate on solutions across the healthcare sector may bring relief, they said while taking part at the Summit on the Future of Rural Health Care in Sioux Falls, SD.
“The administration is very well intentioned, but unfortunately the minimum staffing proposal that they have announced doesn’t recognize the reality, … that the challenge of the 21st century is how do we take care of more people with the same or fewer workers,” he said. Since the pandemic’s start, about 250,000 nursing home staff have been lost due to attrition and 600 nursing homes have closed across the United States.
— McKnight’s Long-Term Care News, October 19, 2023
Staffing Mandates Done Right (Part 3)
“We 100% support mandates, and this is what they should look like: There has to be a guarantee that the government will provide adequate funding to pay market-rate wages, knowing that with increased staffing, rates will need to be substantially higher. The mandates have to have enough flexibility to account for different resident population needs. There should be a stipulation they will only happen when there are enough qualified workers.”
— Senior Living Foresight, October 13, 2023
Loan Reimbursements and Forgiveness May Help Aid Nursing Home Staffing Crisis
With the minimum staffing mandate coming into effect soon, nursing home operators may be looking for creative ways to increase staffing and retain employees.
“If we don’t have the workforce, then that staffing standard falls short. So, we really need to find the supply of workers who can fill those positions that are so desperately needed. Being able to support and incentivize people to come to nursing homes would help address that supply issue,” said Dr. Jasmine Travers, NYU Rory Meyers College of Nursing.
— Skilled Nursing News, September 25, 2023
Given this trend, experts at Skilled Nursing News’ RETHINK conference last week shared ideas on how to tackle rising acuity, including by creating “medical resorts,” using telehealth and predictive analytics to streamline care, creative staffing initiatives to reduce burdens as well as varied payment methods to improve reimbursement.
“We’ve seen acuity rise significantly over the last several years, with the Baby Boomer generation needing to take care of more people, we’re also seeing more complex diagnoses and health conditions,” said Kristen Morris, chief clinical officer at Rockport. “We also have noticed trends and discharges from hospitals, where patients are in the hospital for a shorter amount of time, therefore, we are taking more complex types of patients.”
— Skilled Nursing News, September 19, 2023
The landscape at skilled nursing facilities is evolving rapidly, influenced by factors such as changing regulations, workforce challenges, and the rise of Medicare Advantage, and the minimum staffing proposal only complicates matters.
This view was expressed by industry leaders in the opening session of the Skilled Nursing News’ RETHINK conference Wednesday. Panelists – Wesley Rogers, CEO of Brickyard Healthcare, Phil Scalo, CEO and founder of Bartley Healthcare and Vice Chair of the American Health Care Association (AHCA), and Erin Shvetzoff Hennessey, CEO of Health Dimensions Group – shared their perspectives during a discussion on the topic.
Rogers pointed out that less than 20% of all nursing homes meet the 24/7 staffing requirements for registered nurses (RNs) proposed in the current rule. “It’s not even clear at this point whether you can use [RN] supervisors in that environment,” Scalo said, adding that RNs are usually spread so thin due to a staffing shortage that facilities are incapable of providing an RN for a 24/7 presence currently.
— Skilled Nursing News, September 15, 2023
Message to Health Systems: The ‘New Nurse’ Seeks Flexibility, Not Constraints
Do you feel like you’ve seen more nurses with side hustles lately? Does it seem like more nurses are going per diem or getting additional education?
You aren’t imagining it. Between nurse burnout, the rising cost of living, and professional and personal growth concerns, nurses are getting creative to make ends meet and feel fulfilled in their careers.
— Modern Healthcare
Fixing Long-Term Care’s Staffing Crisis
So here we are, on the cusp of a first-ever staffing mandate for skilled care facilities and things are getting a bit testy.
If we were to [follow Canada, Japan, and Germany’s approach to immigration], we could literally raise the pool of possible frontline workers in long-term care by hundreds of thousands. Almost overnight. Do you think that might help operators deal with the worst staffing crisis this sector has ever seen? Or with minimum staffing mandates?
— McKnight’s Long-Term Care News, June 11, 2023
As Staffing Minimum Looms, Other Workforce Solutions Simmer on Back Burner
“The biggest challenge is that in today’s labor market, the workers simply aren’t there,” Parkinson wrote. “A staffing mandate will not create applicants. And when nursing homes cannot meet this impossible standard, they will have to reduce the number of residents they serve or close entirely, exacerbating the current access to care crisis we’re already seeing unfold.”
— McKnight’s Long-Term Care News, June 2, 2023
