ICYMI: New Analysis Finds Federal Staffing Mandate For Nursing Homes Would Require 100,000 Additional Nurses And Nurses’ Aides, Cost $6.8 Billion Per Year

Regulations; Workforce; Advocacy; Research and Data

In case you missed it, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) released a new analysis during a press conference yesterday by professional services firm CliftonLarsonAllen LLP (CLA), which analyzed the impact of President Biden’s proposed federal staffing mandate on nursing homes. 
The CLA report found:
  • Nursing homes would need to hire an estimated 102,154 additional full-time employees (80,077 nurse aides and 22,077 RNs).
  • The proposed mandate would cost nursing homes approximately $6.8 billion per year – higher than the $4 billion per year estimate from the Centers for Medicare and Medicaid Services (CMS).
  • Ninety-four percent of nursing homes are currently not meeting at least one of the three proposed staffing requirements: the 2.45 nurse aide HPRD, the 0.55 RN HPRD, and the 24/7 RN.
  • Of the 94 percent, 36 percent of facilities are not meeting all three requirements; 34 percent are not meeting two of the requirements; and 24 percent are not meeting one of the requirements.
  • Nursing homes that did not meet at least one of the requirements were more likely to have a majority of their residents relying on Medicaid (56 percent average Medicaid census) compared to facilities that met the criteria (43 percent).
  • If nursing homes are unable to increase their workforce to meet these new requirements, more than 280,000 nursing home residents, or nearly one-quarter of all residents, could be impacted by census reductions.
The press conference featured Mark Parkinson, president and CEO of AHCA/NCAL; Cory Rutledge, chief assurance officer at CLA; and Marie Costa, vice president of clinical services at Revive Health Senior Care Management in Nevada. Watch the full press conference HERE.
Mark Parkinson explained that the CLA findings support what nursing homes are feeling on the ground – that an unfunded, federal staffing requirement is not the way to rebuild the long term care workforce. He explained:
“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. 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. We all want to grow the nursing home workforce, but this impossible policy is absolutely not the way to do it.” 
Cory Rutledge underscored that the Biden Administration’s mandate will be impossible to meet. Rutledge said:
“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. Nursing homes are facing increased operating costs, while still struggling to rebuild their workforce and occupancy rates to pre-pandemic levels. 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.” 
Costa shared how the proposed mandate will affect nursing homes on a personal level, limiting access to care for our vulnerable seniors. Costa said:
“The situation here in Northern Nevada was eye-opening. The [labor] competition here is incredible. So, not only are we competing with nursing homes in the area, but we are surrounded by big factories and retail distribution centers that offer extremely competitive wages. Then on top of that, a local hospital started hiring [licensed practical nurses] LPNs and because of the pandemic, that reality is… the last few years have been tough for [the] long term care workforce to revive. [We’re] already making tough decisions. In February 2022, as a provider that primarily serves Medicaid residents, we chose not to reopen a dually certified wing that serves 60 residents due to labor shortages… 
“The proposed rule would have very real impacts on the people we serve, mostly seniors, we would be very concerned about our ability to meet these requirements and keep our doors open… With this staffing mandate, especially given that it’s unfunded, we simply do not have the means or the resources to attract the right people to work in our centers. Meeting the mandate, it’s not just complicated, it’s impossible. Just like we witnessed our closed wing, our centers will have no choice but to further limit admissions. At this pace, nursing homes will start closing their doors and leave our seniors without care they need.” 
See the full CLA analysis HERE.