LPN Exclusion Triggers Confusion & Questions

Nov 14, 2023 | Minimum Staffing, Nursing HPRD & Turnover

News Digest: Mandated Nursing Minimums Ignores Key Nursing Role

CNA’s, LPN’s and RN’s form the backbone of skilled nursing facilities.  All three roles are used in calculating and determining a facility’s Five Star staffing rating.  Yet the proposed rule for minimum staffing completely ignores LPN’s.  There is wide spread speculation why and whether this changes in the Final Rule.


Nursing, aging service orgs blast CMS for giving LPNs ‘zero credit’ in proposed staffing rule

Several of the nation’s largest aging services and nursing organizations have united to defend Licensed Practical Nurses and criticize a proposed Centers for Medicare & Medicaid Services nursing home staffing rule.

The groups called the conspicuous absence of LPNs from proposed hourly requirements “yet another example of [the mandate’s] fundamental flaws,” and called on CMS rescind the proposed mandate entirely. LPNs make up 13% of the nursing home workforce and complete a large majority of post-acute care work in those facilities, the authors said.

“We are requesting the Administration to withdraw this archaic, unfunded health care policy and instead focus on meaningful, supportive ways to grow and retain the nursing home workforce,” the American Health Care Association, LeadingAge and the National Association of Licensed Practical Nurses and six other organizations wrote in their Oct. 27 comment letter.


Henreckson, Josh. “Nursing, Aging Service Orgs Blast CMS for Giving LPNs ‘Zero Credit’ in Proposed Staffing Rule.” McKnight’s Long-Term Care News, 13 Nov. 2023, www.mcknights.com/news/nursing-aging-service-orgs-blast-cms-for-giving-lpns-zero-credit-in-proposed-staffing-rule.


‘Deeply Flawed’: LPNs Speak Out On Their Exclusion from Nursing Home Staffing Proposal

As advocacy efforts to oppose the federal government’s proposed staffing mandate continue, the National Association for Licensed Practical Nurses (NALPN) is lending its voice towards the withdrawal of the mandate by sharing a joint letter it sent to the federal agency.

The role of licensed practical nurses (LPNs) has been chopped off from the proposal, a stipulation contested in the letter addressed to the Centers for Medicare & Medicaid Services’ (CMS) administrator, Chiquita Brooks-LaSure.

“It is evident that LPNs are essential members of a coordinated care team, [and] yet the proposed federal staffing mandate gives absolutely zero credit to the vital role they play as licensed nurses. To not include LPNs with RNs is an affront to their hard work and dedication to the residents they serve,” the letter states.


Zahida Siddiqi. “‘Deeply Flawed’: LPNs Speak Out on Their Exclusion From Nursing Home Staffing Proposal.” Skilled Nursing News, 14 Nov. 2023, skillednursingnews.com/2023/11/deeply-flawed-lpns-speak-out-on-their-exclusion-from-nursing-home-staffing-proposal.


Proposed Federal Nursing Home Mandates Undermine Progress in Florida, Exacerbate Workforce Shortage According to New Study

A new analysis reveals the harmful and costly impacts the Biden administration’s recently announced federal staffing mandates will have on Florida nursing centers and their residents. According to the study by professional services firm CLA (CliftonLarsenAllen, LLP), the federal Centers for Medicare and Medicaid Services (CMS) proposed staffing mandate will cost Florida nursing centers an additional $188 million, despite Florida already having comprehensive staffing standards. In many categories, Florida standards already exceed what is required by the federal mandate.

Florida’s staffing standards recognize the different needs of each resident and provide flexibility for centers to staff according to those unique needs. Along with required nursing hours, Florida’s standards also recognize the important role of social workers, activity staff, and therapists in delivering quality care.


Proposed Federal Nursing Home Mandates Undermine Progress in Florida, Exacerbate Workforce Shortage According to New Study |  Florida Health Care Association. www.fhca.org/media_center/entry/Study_shows_impact_of_CMSstaffingproposal.


LPN Exclusion in CMS Staffing Mandate a ‘Convoluted Mess’ for Nursing Homes

The skilled nursing industry is at a crossroads as it grapples with the Centers for Medicare & Medicaid Services’ (CMS) proposed federal staffing mandate. A significant point of contention in the proposal is the exclusion of licensed practical nurses (LPNs), which has ignited concerns and garnered strong reactions from industry leaders.

“What’s keeping me up right now is the policy nightmare,” Mark Parkinson, CEO and president of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said at the organization’s recent Annual Convention and Expo in Denver. “The proposed staffing rule is an overreaction — a poor reaction to a horrible crisis that we all experienced.”


Shelby Grebbin. “LPN Exclusion in CMS Staffing Mandate a ‘Convoluted Mess’ for Nursing Homes.” Skilled Nursing News, 9 Oct. 2023, skillednursingnews.com/2023/10/lpn-exclusion-in-cms-staffing-mandate-a-convoluted-mess-for-nursing-homes.


Disrupting an ‘ecosystem that works’: Providers rip staffing mandate’s LPN omission

As operators continue to parse a proposed federal staffing mandate, one of the biggest concerns is for workers who get little attention in the proposed regulations: the licensed practical nurses whom many consider to be the sector’s nursing backbone.

In bypassing hourly requirements for LPNs, some fear the Centers for Medicare & Medicaid Services is undercutting the critical role that such shift nurses play in direct patient care.

“LPNs exist in our sector because there was a huge gap in the workforce of [registered] nurses that were willing to work in post-acute care. The LPN role has become probably 75 to 80% of the workforce in post-acute care. To eliminate them is huge. It’s huge,” said Sally Cantwell, PhD, RN, senior director of recruitment and retention at PACS, a management and consultant group that employs about 5,700 LPNs or LVNs in supporting close to 200 US nursing homes.


Marselas, Kimberly. “Disrupting an ‘Ecosystem That Works’: Providers Rip Staffing Mandate’s LPN Omission.” McKnight’s Long-Term Care News, 25 Sept. 2023, www.mcknights.com/news/disrupting-an-ecosystem-that-works-providers-rip-staffing-mandates-lpn-omission.


‘A Strange Rule’: Policy Experts Call for Changes, Compromise to Staffing Proposal for Nursing Homes

Leaders from across the sector – nurses and policy experts – are urging lawmakers to more carefully consider some of the stipulations of the nursing home staffing proposal, including the ratios of direct care staff, timing and even financial factors that may ultimately prevent the industry from complying with its conditions.

The Centers for Medicare & Medicaid Services’ (CMS) staffing proposal calls for Medicare- and Medicaid-certified nursing homes to provide a minimum of 0.55 hours per resident per day of care from registered nurses (RNs) and 2.45 hours of care from certified nursing assistants (CNAs), with non-rural nursing homes having 3 years and rural nursing homes have 5 years to meet these standards.

“It’s a little bit of a strange rule,” said David Graboswki, a health policy expert from Harvard University, who has testified before Congress on many legislative issues related to the nursing home sector. “[Of] the three direct care staff types in a nursing home, two of them now have a number that [federal authorities] say that nursing homes have to step up to the other one, which was completely ignored in the legislation.”


Shelby Grebbin. “‘A Strange Rule’: Policy Experts Call for Changes, Compromise to Staffing Proposal for Nursing Homes.” Skilled Nursing News, 22 Sept. 2023, skillednursingnews.com/2023/09/a-strange-rule-policy-experts-call-for-changes-compromise-to-staffing-proposal-for-nursing-homes.


CMS ‘naive’ about staffing minimum proposal details, professor claims

The proposed federal staffing rule is “shockingly low” and will not measurably improve working and care conditions in nursing homes, consumer advocates claimed during a webinar that was conducted without any provider representation Tuesday.

Charlene Harrington, RN, PhD, professor emeritus at the University of California-San Francisco School of Nursing, sharply criticized the proposed federal mandate for not going far enough during the webinar presented by the Long-Term Care Community Coalition.

“They’re shockingly low,” she said of the proposed nursing hours. “The government basically ignored all of the research after lobbying by the nursing home industry.”


Towhey, Jessica R. “CMS ‘Naive’ About Staffing Minimum Proposal Details, Professor Claims.” McKnight’s Long-Term Care News, 20 Sept. 2023, www.mcknights.com/news/cms-naive-about-staffing-minimum-proposal-details-professor-claims.


A slap in the face for LPNs who keep nursing homes running

More than two weeks after its debut, a proposed staffing mandate for the nation’s 15,000 nursing homes seems to be all skilled nursing operators can talk about.

And why not?

The rule has the potential to change nearly everything about the skilled nursing workforce, from the total time direct care staff spend with patients to the oversight and hands-on care provided by a lot more registered nurses.

But there may be no one as worried as the thousands of licensed practical nurses who currently provide critical services in skilled nursing.


Marselas, Kimberly. “A Slap in the Face for LPNs Who Keep Nursing Homes Running.” McKnight’s Long-Term Care News, 20 Sept. 2023, www.mcknights.com/daily-editors-notes/a-slap-in-the-face-for-lpns-who-keep-nursing-homes-running.


AHCA CEO: Staffing Mandate Proposal ‘Inherently Flawed,’ with ‘Complete Disrespect’ to LPNs Puzzling

The federal minimum staffing proposal was rushed through and is “inherently flawed” to a degree that makes it possible to defeat, according to the chief of the nation’s largest nursing home association.

In a wide ranging conversation at the Skilled Nursing News (SNN) RETHINK conference in Chicago last week, Mark Parkinson, president and CEO of the American Health Care Association (AHCA), said problems with the staffing proposal stem from lack of funding and the federal government ignoring the regional differences in staffing, census and reimbursement, among other issues.


Zahida Siddiqi. “AHCA CEO: Staffing Mandate Proposal ‘Inherently Flawed,’ With ‘Complete Disrespect’ to LPNs Puzzling.” Skilled Nursing News, 19 Sept. 2023, skillednursingnews.com/2023/09/ahca-ceo-staffing-mandate-proposal-inherently-flawed-with-complete-disrespect-to-lpns-puzzling.

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