For skilled nursing facilities, payroll-based journal (PBJ) data will almost certainly serve as the compliance baseline under any finalized staffing rule, meaning existing staffing gaps already documented in PBJ submissions represent direct regulatory and survey exposure.
AHCA warns White House about ‘one-size-fits all’ staffing mandate, offers 4-point plan of its own
“We understand that the original intent of proposing additional federal staffing requirements is to enhance care — nursing home providers share in this noble cause. In reality, staffing mandates will only limit access to care for our nation’s seniors, as nursing homes will be forced to restrict the number of residents they can serve, or close altogether.”
The provider group also offered four recommendations the federal government could implement instead of a national staffing rule that could result in drastic, “unintended consequences.” The recommendations are well-known to close observers as proposals AHCA has also made previously in its reform plans.
— McKnight’s Long-Term Care, July 25, 2023
AHCA to White House: Nursing home staffing mandate spells ‘disaster’
A federal nursing home staffing mandate would be “impossible to implement” and a “disaster,” especially for seniors on Medicaid, the American Health Care Association/National Center for Assisted Living warned in a letter sent to President Biden Tuesday.
“If your administration imposes this mandate, more nursing homes will close, especially facilities that uniquely serve our most vulnerable. Nursing homes that primarily care for residents on Medicaid won’t have the resources to recruit staff or pay for this mandate. Those facilities, as well as those who they serve and employ, will be hurt the most.”
— McKnight’s Long-Term Care, July 13, 2023
Minimum staffing requirements good idea in theory only: AHCA/NCAL
A federal nursing home minimum staffing mandate “sounds like a good idea, but in practice, it is not,” American Health Care Association / National Center for Assisted Living President and CEO Mark Parkinson told President Biden in a letter Tuesday.
“Instead of a mandate, we need to implement 21st Century solutions to this 21st Century problem. Those include changing our immigration policies to attract thousands of international nurses, using innovative technology to help provide better care with fewer people, and continuing our efforts to help seniors stay at home as long as possible.”
— McKnight’s Senior Living, July 13, 2023
Advocates intensify behind-the-scenes efforts as staffing minimum stalls
“We have had discussions with the Administration, as have many other stakeholders, and we believe that the Administration is taking the time to thoughtfully consider how we marry policy with practicality. We all want to increase the long-term care workforce, but an enforcement approach will not solve this labor crisis and will only worsen access to care for seniors.”
— McKnight’s Long-Term Care, June 30, 2023
AHCA prepared to sue over minimum staffing mandate
A top executive of the largest US nursing home trade association said Tuesday his group is prepared to take legal action if an upcoming federal staffing mandate proves to be overly prescriptive.
More than 500 members of the American Health Care Association/National Center for Assisted Living gathered here this week for meetings with their Congressional representatives.
“If it’s going to be bad, the question is how bad. I think we’ve shaped the ‘how bad,’ but we’re still going to need to work on fixing it.” On legal action: “I hope we don’t have to, but we’re ready if we do,” said AHCA SVP of Government Relations Clif Porter II, noting that the AHCA board had already approved litigation if it became necessary.
— McKnight’s Long-Term Care, June 7, 2023
At a time when the industry is still reeling from the effects of massive worker shortages that were worsened during the pandemic, and as the sector lags other areas of health care in recovering from labor challenges, nursing home executives and advocacy group leaders said any minimum staffing measure would be punitive.
“[A staffing minimum] will make things worse. It will cause beds to shut down. It will cause wings to close, and unfortunately, it will accelerate the closures of nursing homes. I know that the folks that want to do this are well-intentioned, but the results will be the opposite of what they want. Seniors will not be benefited. They will be hurt because access will decline.”
— Skilled Nursing News, June 6, 2023
In nursing homes we don’t trust
The juxtaposition could hardly be more jarring.
As this goes to press, the nursing home industry is anxiously waiting for the federal government to release a first-ever staffing mandate.
When that happens, operators will be under unprecedented pressure to fill every available position. It’s also safe to predict the field will need to rely more on a key labor source: workers born elsewhere.
— McKnight’s Long-Term Care, June 5, 2023
On federal staffing minimum, providers need protections: AHCA’s Phil Fogg
Phil Fogg, board chairman of the American Health Care Association, said providers must be confident that they won’t be punished for not meeting what could be an impossible standard, given the current workforce challenges.
“You just can’t send a rule out and expect people to comply when there’s absolutely no chance of it because of the workforce shortages. We can’t have penalties to those providers or survey deficiencies to those providers who have made those best efforts and the workforce supply just isn’t there.”
— McKnight’s Long-Term Care, May 24, 2023
Parkinson said labor shortages are still plaguing the nursing home industry even as other subsectors in health care have recovered, and any regulation that fails to account for this crisis will be disastrous as the industry remains short of more than 200,000 workers.
“It is ridiculous to enforce a staffing mandate … when you’ve got this kind of data. It’s ridiculous to create one in D.C. when you’ve got this kind of data.” On the sector’s response: “It’s not a done deal. It’s a proposed rule that we have the opportunity to comment on and to fight, and we will.”
— Skilled Nursing News, May 9, 2023
Lawmakers, union attack AHCA’s opposition to nursing home staffing mandate
Two members of Congress joined national union leaders Thursday in accusing nursing home owners of diverting federal funds away from patient care in what was ostensibly a rally in support of a federal staffing mandate.
“We are not against hiring more staff — we would love to hire more caregivers, but in this current labor market and with limited resources, the workers simply do not exist. It will be impossible for nursing homes to meet an unfunded mandate without any supporting workforce development programs or funding. It’s our nation’s seniors who will feel the impact if this policy proceeds — with fewer options and longer waiting periods for care.”
— McKnight’s Long-Term Care, April 21, 2023
AHA, AHCA Issue Joint Letter to CMS Outlining Staffing Mandate Concerns
The American Hospital Association (AHA) and American Health Care Association (AHCA) sent a joint letter to the Centers for Medicare and Medicaid Services on Monday expressing their concerns about the proposed federal staffing mandate.
“We anticipate many nursing homes will be forced to further reduce their capacity and even close their doors if they are unable to meet these staffing mandates. This would accelerate the domino effect across the entire continuum of care and leave vulnerable seniors with fewer care options.”
— HealthLeaders Media, April 4, 2023
Provider groups push back on planned nursing home staff mandates
Two major hospital groups are pushing back against the CMS’ plans this year to issue federal staffing minimums for nursing homes, according to a Monday letter sent to CMS Administrator Chiquita Brooks-LaSure from the American Hospital Association and American Health Care Association.
“In short, specific staffing levels should be a clinical decision customized to the resident population and facility characteristics rather than a policy decision made with lack of regard to real-life situations.” The joint letter also warned: “This has a detrimental impact on patients who must wait days, weeks, or even months in hospital beds awaiting discharge to post-acute care; the capacity of care providers to serve our communities; and the costs to the entire health care system.”
— Healthcare Dive, April 4, 2023
Long-term care struggles to rebound to pre-pandemic staffing levels: analysis
Staffing in long-term care dropped drastically at the start of the pandemic and is unlikely to rebound to pre-pandemic levels until 2027. That’s according to a recent analysis of US Census data by the American Health Care Association / National Center for Assisted Living.
“The data doesn’t lie. This is not just an exaggerated call for help, and this labor crisis will not go away on its own or through government enforcement.” AHCA/NCAL analysis found all long-term care providers collectively lost 307,000 jobs from February 2020 to December 2022, with nursing homes accounting for 210,000 of those losses — a 13.3% drop that left the nursing home workforce at levels not seen since 1994.
— McKnight’s Senior Living, January 23, 2023
Data Doesn’t Lie: Current Pace Sets Nursing Home Workforce Recovery Back to 2027
“The data doesn’t lie,” Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement. “This is not just an exaggerated call for help, and this labor crisis will not go away on its own or through government enforcement.”
“Our nursing homes are struggling to recruit caregivers, and if we do not get meaningful assistance soon, then the consequence will be hundreds of thousands of seniors displaced. We need immediate support, but we also need long-term investments and programs from policymakers to attract individuals to serve our nation’s seniors.”
— Skilled Nursing News, January 19, 2023
80% of Nursing Home Providers ‘Very Concerned’ About Possible Federal Staffing Mandate
A vast majority of nursing homes favor extending the public health emergency designation for Covid, and are concerned that they will be unable to meet a potential federal staffing minimum.
“Government staffing mandates will not solve the core issue here. We need a concerted, collective effort with proper resources and incentives to help recruit more individuals to work in long term care.” The survey found about 80% of nursing homes were “very concerned” they would be unable to meet a potential 4.1 HPRD federal staffing minimum due to a labor shortage, rising inflation, and higher operating costs.
— Skilled Nursing News, January 10, 2023
Survey: Nursing Home Providers Say Workforce and Economic Challenges Persist
“Nursing homes have done everything they can on a fixed government budget—they cannot solve this crisis on their own. We need policymakers to invest in long term care, so we can compete for health care workers, transform America’s nursing homes, and prepare for a growing elderly population.” Nearly all respondents (95%) were concerned about meeting a 4.1 HPRD staffing minimum, including 79% who were “very concerned.”
— AHCA/NCAL, January 10, 2023
Parkinson: Nursing home sector pinning hopes on ‘Medicaid adequacy’ rule
The solution could lie in the Centers for Medicare & Medicaid Services universally demanding that states prop up Medicaid payments, said Mark Parkinson, the president and CEO of the American Health Care Association/National Center for Assisted Living, during a media briefing Tuesday at the group’s annual meeting.
“CMS has talked about really putting some teeth into its authority to require states to pay an adequate amount of Medicaid — for all healthcare providers, not just skilled nursing facilities. In far too many states right now, the reimbursement for Medicaid is dramatically less than the actual cost of taking care of people in nursing facilities.”
— McKnight’s Long-Term Care, October 11, 2022
Experts Question How Nursing Homes Will Pay For More Staff Amid Anticipated Minimum Staffing Mandate
“There is a huge national shortfall in nursing home workers right now. Nursing homes will need to raise wages to recruit additional staff. Where does this money for higher wages come from? There are no additional reimbursement dollars in the current [White House] reform package … I think the minimum staffing standard is a step forward, but I am worried about how facilities will fund these new staff.” — Dr. David Grabowski, professor of health care policy, Harvard Medical School and MedPAC commissioner.
— AHCA/NCAL, October 7, 2022
