What They Are Saying: U.S. Senate Committee On Veterans’ Affairs Hearing Shines Light On Long Term Care Workforce Crisis

Senators Question CMS on Merits of a Staffing Mandate for Nursing Homes

Advocacy; Regulations; Workforce

On Wednesday, June 7, members of the U.S. Senate Committee on Veterans’ Affairs and nursing home providers discussed the workforce crisis that is facing state veterans’ homes and the long term care sector as a whole during their hearing, “An Abiding Commitment to Those Who Served: Examining Veterans’ Access to LTC.”
In a discussion with Jonathan Blum, principal deputy administrator & chief operating officer for the Centers for Medicare and Medicaid Services (CMS), Senator Angus King (I-ME) called a federal staffing mandate for nursing homes “unrealistic.” He highlighted nursing home closures in Maine and emphasized the need for programs that will train and retain staff: 
“It's not enough to say, we're going to have a good staff and we're going to have enough staff. I want to hear how you're going to make that happen, because we're losing nursing homes generally in Maine, because of a lack of staff. And so, let's have some programs to retain, raises, training, career ladder…whatever it's going to take, but that's what I want to hear. And to start with what I believe may be unrealistic standards, it seems to me it’s backwards. We should start with the programs to build the staff and maintain the staff that we have, then talk about increasing.” 
Senator King went on to highlight just how unrealistic a staffing mandate is in the current environment, saying “everybody wants more staffing, but I’d like a date with Angelina Jolie but it ain’t going to happen.” He added, “you can’t conjure people out of thin air.”
Despite the lack of available workforce, CMS is expected to issue a federal staffing mandate imminently. Senator Jon Tester (D-MT), whose state experienced 11 nursing homes closures in 2022, expressed concern:
“I know you want higher outcomes, we want higher outcomes. But I think the point Senator King made that closing down a rest home isn't a higher outcome, necessarily. Not that there isn't times when that needs to happen, but we certainly don't want that to happen just because they have no other choice because they can't meet the staffing mandate.”
Senator Kevin Cramer (R-ND) also raised concerns to Blum around the staffing challenges within long term care facilities. He also voiced his opinion that a mandate is not the correct solution:
“I want to talk specifically about the staffing challenges. I mean, I hear it everywhere, it’s not new. It’s not new to this industry, it’s every industry. But it is particularly problematic, obviously, in health care. And I’ve worried a lot about the use of contract nurses. And yet, when you need workers, you need workers. And I’m a little concerned about the talk of staffing ratio mandates and the impact that would have on an already very stressed situation. How does that policy help? I guess that is the bottom line. Can we please change it, or drop it, or admit we were wrong?” 
Carla Wilton, chief operating officer of Immanuel Lutheran Communities, a full-service retirement community in Kalispell, Montana, explained why it’s difficult to hire workers in the Treasure State:
“[Recruiting] CNAs (certified nursing assistants) is difficult. […] Housing has gotten really expensive and we're starting our CNAs close to $20 an hour they can't afford to rent an apartment. So, it is hard to recruit CNAs and if you live somewhere, we happen to live in a place that has a lot of summer traffic. And during the summer, we compete heavily with hotels and restaurants, in our housekeeping and dining departments. I would say it's hard across the board.” 
Wilton testified that Immanuel Lutheran is losing $80-100 each day on their Medicaid residents, affecting their ability to recruit workers. She also discussed the recent loss of workers within the nursing home sector and the impact it has had on access to care for local residents:
“As you've heard, during the pandemic, nursing homes across the United States lost nearly 250,000 workers. That was 15 percent of our workforce and we continue to struggle to recruit and rebuild. In Montana, we lost over 1,000 of our 5,500 workers - nearly 20 percent. Immanuel experienced similar losses of team members during this time. Sometimes we were unable to admit new residents due to our inability to care for them because of our low staffing numbers. We raised staff wages almost 25 percent across the board, and for the first time in our organization’s 65-year history, we brought in agency staff. Although this came at great expense, we have a responsibility to provide services to those living on our campus.” 
As the labor crisis continues, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has continued to call on Congress to invest in the sector and workforce recruitment programs rather than implement an unfunded staffing mandate. Without comprehensive solutions, more long term care facilities, including veterans’ homes, will be forced to limit admissions or close, threatening access to care for our nation’s veterans and seniors. 
Watch Senator King’s remarks HERE.
Watch Carla Wilton’s remarks HERE.
Watch the full U.S. Senate Committee on Veterans’ Affairs hearing HERE.