Nursing home leaders descended on Washington, D.C. this week to voice their vehement opposition to a federal staffing mandate, arguing it would exacerbate existing workforce shortages and cripple the long-term care sector.
The gathering, spearheaded by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and LeadingAge, follows the finalization of the staffing rule by the Centers for Medicare & Medicaid Services (CMS). Industry leaders warn the rule, which mandates specific nurse staffing levels, is unrealistic and could lead to facility closures and reduced access to care for seniors.
Unfunded Mandate, Unrealistic Requirements
Mark Parkinson, president and CEO of AHCA, highlighted the financial strain the mandate would place on facilities, many of which already struggle with low Medicaid reimbursement rates. He estimates the cost of compliance could reach $400,000 annually, requiring an additional 102,000 registered nurses (RNs) and certified nursing assistants (CNAs) nationwide – a tall order in a market facing a severe labor shortage.
“Everyone here wants more staffing in facilities,” Parkinson said. “However, the staffing mandate does not solve the problem and, in many respects, makes it worse.”
Workforce Shortage Makes Compliance Difficult
Katie Smith Sloan, president and CEO of LeadingAge, echoed Parkinson’s concerns. She pointed out the disconnect between the mandate’s demands and the current workforce supply.
“Our current infrastructure of long-term care cannot sustain staffing mandates until they are supported by adequate funding and available staff,” Sloan said. “Where will those 100,000-plus qualified, caring individuals come from?”
A Call for Solutions, Not Mandates
Both Parkinson and Sloan urged policymakers to focus on long-term solutions to the workforce crisis, such as aligning reimbursement rates with the cost of care, increasing wages to attract and retain staff, and implementing immigration reform to address the shortage of qualified caregivers.
“We need real policy solutions and investments, not mandates,” Sloan said. “We are drawing on every available tool to stop this rule’s implementation and to address the fundamental issue of building the long-term care workforce.”
Litigation Concerns Add to the Animosity
Adding fuel to the fire, AHCA/NCAL worries the detailed facility assessments required under the mandate could become ammunition for lawsuits against nursing homes.
“This is a means to strengthen not only enforcement but to strengthen litigious activities to ultimately put us in a situation that’s going to make delivering care that much more difficult,” said Clif Porter, senior vice president of government relations for AHCA/NCAL.
Industry Ponders Next Steps
The industry is taking a multi-pronged approach to fight the mandate. LeadingAge has joined AHCA’s lawsuit to block the rule, while both organizations are lobbying lawmakers for a legislative solution.
Time will tell if their efforts will succeed, but one thing is clear: the battle lines are drawn between the nursing home industry and the federal government over how best to ensure quality care for our aging population.