WASHINGTON, D.C. — A study commissioned by the Centers for Medicare & Medicaid Services (CMS) intended to identify appropriate staffing levels for nursing homes found there was no single staffing level that would guarantee quality care, KFF Health News exclusively
reported yesterday. The findings call into question the evidence and rationale of a federal staffing mandate expected to be issued soon by the Biden Administration.
“This report confirms what we’ve been saying for more than a year – that an arbitrary staffing mandate is not feasible and will not equate to higher quality care,” said Mark Parkinson, president and CEO of the American Health Care Association (AHCA). “There needs to be a comprehensive approach to staffing beyond numbers, acknowledging that each resident and facility is unique. We all want to increase the nursing home workforce, but instead of blanket requirements during a historic labor shortage, we need resources and policies that will help recruit and retain more caregivers. In light of these findings, we urge the Administration to reconsider this proposal and focus on more meaningful ways to improve quality and address the long term care workforce crisis.”
According to KFF Health News, the study was commissioned by CMS to identify the appropriate staffing levels, but made no specific recommendations and ultimately found there was “no obvious plateau at which quality and safety are maximized or ‘cliff’ below which quality and safety steeply decline.” Researchers also wrote that, “Recent literature underscores the relationship between nursing home staffing and quality outcomes... However, it does not provide a clear evidence basis for setting a minimum staffing level.”
AHCA’s Senior Vice President of Quality, Regulatory and Clinical Services Holly Harmon told KFF Health News, “What is clear as you look across the country is every nursing home is unique and a one-size-fits-all approach does not work.”
CMS drew the
same conclusion in 2016 during President Obama’s Administration, in which the agency expressed concern about the unintended consequences of a mandatory staffing ratio. The agency recommended that the administration not move forward with establishing such a regulation, stating, “[T]his is a complex issue and we do not agree that a ‘one size fits all’ approach is best.”
In the recently leaked study, researchers also concluded that “additional staffing costs, estimated in the billions, could be a parallel barrier to implementation.” Based on the staffing level scenarios the researchers examined, “the total costs could range from $1.5 to $6.8 billion annually depending on the structure and option.” Other experts have analyzed the costs associated with implementing a 4.1 hours per day staffing minimum, which would require
$11.7 billion a year.
The new CMS study comes on the heels of new data underscoring the growing crisis around access to nursing home care. A report from
The Wall Street Journal found the number of nursing home beds continues to decline due to historic labor shortages. Today, there are more than 600 fewer nursing homes in the U.S. than there were just six years ago. AHCA/NCAL’s
Access to Care Report found that 579 nursing homes closed during the pandemic, displacing more than 21,000 residents. If the Biden Administration follows through with a federal staffing mandate, more than 400,000 nursing home residents are at risk of displacement if facilities are unable to increase their workforce and must reduce their census to meet the arbitrary requirement.
AHCA sent a
letter to President Biden last month, urging the president to re-evaluate the proposal. “It's not too late to reconsider this staffing mandate proposal and refocus on more meaningful solutions,” wrote Parkinson. In a subsequent
letter, the association put forth four specific recommendations that would advance quality care in nursing homes as opposed to a federal staffing mandate. This included policies to build the long term care workforce, publicly report customer satisfaction, and enhance Medicare’s value-based purchasing program.