Sens. Deb Fischer (R-NE) and James Lankford (R-OK) have reintroduced a bill aimed at overturning the federal nursing home staffing mandate, just as Congress intensifies its efforts to address sweeping cuts to government spending. The timing is significant, as it coincides with the looming financial negotiations, with some lawmakers seeking to fast-track fiscal reductions via budget reconciliation.
The bill, Protecting Rural Seniors’ Access to Care Act, was reintroduced in the Senate on Wednesday, following a companion measure introduced in the House last week by Rep. Michelle Fischbach (R-MN). Senate leaders are targeting Fischer’s legislation for inclusion in the ongoing budget reconciliation process, citing a Congressional Budget Office estimate that the staffing mandate could cost the federal government $22 billion over the next decade.
The Staffing Mandate and Its Implications
The Biden administration’s staffing rule, finalized in May 2024, mandates 24/7 nursing coverage and a minimum of 3.48 hours of total nursing care per resident daily. This rule has raised concerns, particularly as the nursing home industry continues to grapple with the aftermath of the pandemic, which left a workforce deficit of over 200,000 frontline workers.
Fischer, in her floor speech, emphasized the burden the rule would place on already stretched providers, particularly in rural areas. “Nursing homes are few and far between in rural areas of our country. If one facility closes, the next closest one could be many miles or even hours away. Just one closure could be detrimental to seniors in some of our communities,” Fischer stated. She also cited the closure of 44 nursing homes in Nebraska alone since 2015.
Clif Porter, President and CEO of the American Health Care Association (AHCA), echoed these concerns, warning that the mandate would lead to further closures, displacing tens of thousands of residents. “The concerns in Congress we’ve seen on both sides of the aisle reaffirm what the profession has been saying for years: These unrealistic standards will only force more nursing homes to downsize or close,” Porter said.
Support and Opposition
The bill has garnered widespread support from industry groups, including AHCA, LeadingAge, and the American Hospital Association (AHA). These organizations argue that while the staffing mandate is well-intentioned, it does not address the root causes of the workforce shortage. Katie Smith Sloan, President and CEO of LeadingAge, highlighted the challenge, stating, “The federal staffing mandate does not include any funding to help pay for staff recruitment and training. Without staff, there is no care; shortages force providers to make difficult choices, including limiting admissions or even ceasing operations.”
Providers are also seeking legal relief in two ongoing federal court cases challenging the mandate, but the timing of the legislative push remains critical, as Congress aims to identify spending cuts to offset other financial priorities.
The Path Forward
In a broader context, lawmakers see Fischer’s bill as a potential solution that could ease the pressure on the nursing home industry. With the federal staffing mandate poised to cost billions and risk further closures, Fischer’s legislation aims to create a task force to study workforce issues in the skilled nursing sector, while allowing time for more thoughtful, targeted solutions.
Rep. Fischbach summarized the argument: “The Biden Administration’s HHS nursing staff mandate was a half-baked, one-size-fits-none plan that will not solve the nursing staff shortage and will hurt nursing home facilities all across Minnesota’s Seventh District,” she said.
As the bill makes its way through Congress, both sides of the aisle will need to navigate the complex dynamics of federal spending cuts and workforce shortages in the nursing home sector.