In case you missed it, the Biden Administration
announced the Nursing Home Minimum Staffing Final Rule this week. This one-size-fits-all requirement from the Centers for Medicare and Medicaid Services (CMS) will exacerbate the workforce crisis in nursing homes, jeopardizing access to care for our seniors. The American Health Care Association (AHCA) released a
statement in response to the finalization of the rule:
"It is unconscionable that the Administration is finalizing this rule given our nation's changing demographics and growing caregiver shortage. Issuing a final rule that demands hundreds of thousands of additional caregivers when there's a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn't magically solve the nursing crisis.
“Staffing minimums are a 20th Century solution for a 21st Century problem. Now the Administration has gone ever farther than originally proposed, making these requirements even more out of touch and out of reach. At the end of the day, the agency is overstepping with a one-size-fits-all enforcement approach that is deeply flawed.”
The finalization of this requirement has been met with bipartisan opposition from lawmakers, as well as long term care leaders and health care policy experts across the country, who warn that the rule will force many nursing homes to close and displace vulnerable seniors. U.S. Senators Deb Fischer (R-NE) and Jon Tester (D-MT) previously introduced legislation, the Protecting Rural Seniors’ Access to Care Act, that would prohibit the U.S. Department of Health and Human Services (HHS) from being able to finalize the proposed staffing requirement for nursing homes. The House companion bill was introduced by U.S. Representatives Michelle Fischbach (R-MN-07) and Greg Pence (R-IN-06), and co-sponsored by Representative Jared Golden (D-ME-02).
See what Members of Congress are saying in the wake of the rule’s release:
U.S. Senator Jon Tester (D-MT):
“I have serious concerns that the Biden Administration's one-size-fits-all staffing mandate will be unworkable for rural nursing homes. While well-intentioned, the burdensome requirement fails to address concerns I've heard from local providers in Montana.”
U.S. Senator Kevin Cramer (R-ND):
“Today [CMS] published the final rule mandating new long-term care facility staffing requirements. Last year, I led a bipartisan letter expressing concern over CMS’ misguided approach. This flawed rule will reduce access to care for seniors & veterans.”
“Time and again, this administration has abandoned rural America, leaving working families and small businesses in the dust. Instead of listening to the overwhelming, bipartisan opposition to this rule, the administration has decided to plow ahead. This misguided rule will devastate nursing homes across this country and worsen the staffing shortages we are already facing.”
“The President’s one-size-fits-all, Washington-knows-best approach to long-term care is an unfunded mandate that will drive up costs and threaten access for patients. The minimum staff-to-patient ratio is unworkable for nearly 80 percent of nursing homes, requiring facilities to increase costs for patients or close their doors to new patients. The so-called ‘access rule’ creates untenable standards for home health agencies to meet. Both rules in practice will result in reduced access to care for those that need it most and their families."
“This rule will hurt rural communities, and it will NOT solve the nursing staff shortage. I know it. Rural facilities know it. Even CMS knows it and yet they're still moving forward. It's time to pass my bill to keep this rule from being implemented.”
U.S. Representative John Rose (R-TN-06):
“The Biden Administration plans to force Tennessee nursing homes to hire 2,600 more nurses and nurse aids, costing $150 million more every year. The unintended consequence of this sweeping rule is overwhelming expense to families and the most elderly among us. There has to be a balance between quality care and affordability. This top-down mandate from Washington is out of touch with reality, especially for our rural communities.”
“The Biden administration’s arbitrary staffing mandates for nursing homes would force these critical facilities to close in rural communities, including [Indiana’s fourth district]. Top-down, government-knows-best rules are not the solution to providing exceptional care for our seniors.”
It’s not just lawmakers who are sounding the alarm on the rule. Voices from the health care industry have expressed concerns that the staffing requirement will cause ripple effects across the entire health care system:
Stacey Hughes, executive vice president, American Hospital Association (AHA):
“CMS’ one-size-fits-all minimum staffing rule for nursing homes creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements. This final rule could lead nursing homes to reduce capacity or close outright, including those that are otherwise high performers on quality and safety metrics. The loss of these nursing home beds could adversely impact patients who have completed their hospital treatment and need continuing care in nursing facilities.”
“NRHA appreciates and concurs with CMS’ commitment to improving resident safety in nursing homes but is extremely concerned about the consequences of this rule on rural beneficiary access to care. Rural facilities are facing historic nursing shortages, inflation, and inadequate reimbursement, leading to a wave of rural facility closures. A blanket, unfunded staffing mandate will threaten the viability of rural nursing homes and further jeopardize access to post-acute care for rural residents.”
“We have a health care workforce crisis right now. And if this mandate would go into effect, it would exacerbate it to the point where many, many rural facilities would close … I think it's important to just acknowledge the fact that facilities have a staffing requirement right now. We have a high quality of care and our nursing facilities across the state … I believe in Nebraska that a one size fits up fits all approach to staffing is not a good path to quality, that individualized care for facilities is able to staff to meet their resident need, which is how it is today is a better path forward.”
“This staffing mandate is unrealistic in light of the historic and deepening care giver shortage and more nursing homes are at risk of downsizing or having to close. Maine has already lost 25 nursing homes since 2014. Further, this is an unfunded mandate.”
“It’s impossible to imagine how a skilled nursing facility in a town of 1,500 people will be able to find 24/7 coverage for an RN when they already have open RN positions they can’t fill today. Instead of requiring an RN to be in a rural nursing home 24 hours a day, why not create a pathway to complement care with virtual RN services? Virtual care is a common-sense, forward-looking approach to support resident care needs while protecting access to care. It’s disappointing that CMS seemingly looked backwards by not including this flexibility in the final rule.”
“I get the administration and the government really need to fortify staffing in our nation’s nursing homes. I completely get it. [But] anyone who’s worked in a nursing home since COVID would understand that that supply of staffing simply is not there.”
“The extra increase in staffing hours and the 24/7 RN requirement are not even possible with growing patient numbers and a shrinking talent pool. It’s a fairy tale. They don’t exist.”
Prior to the finalization of the rule, lawmakers from both sides of the aisle, policy experts and long term care advocates
vocalized opposition to a federal staffing mandate for nursing homes. Despite concerns over the flawed policy approach, the Biden Administration has chosen to finalize a rule that will only limit access to care for our most vulnerable.