American Healthcare Association criticizes Biden’s nursing home staffing rule, calls for open dialogue.
After President Joe Biden delivered his 2022 State of The Union Address, outlining his proposed measures to improve healthcare, the industry has been actively engaging with the administration to reach a consensus on guidelines that would benefit payments and staff. The recently released staffing level mandates have faced widespread criticism from nursing home groups and staff representatives.
The White House has stated that the new initiatives aim to enhance the safety and quality of care in nursing homes, with a focus on addressing establishments that consistently understaff their facilities, resulting in substandard care that puts residents at risk.
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During his State of the Union address last year, President Biden emphasized his administration’s commitment to cracking down on nursing homes that commit fraud, endanger patient safety, or prescribe unnecessary drugs.
In a press conference on Tuesday, Mark Parkinson, the President and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), expressed serious concerns about the Biden administration’s proposals. While acknowledging the organization’s dedication to improving care quality and staffing levels, Parkinson raised significant issues regarding the potential unintended consequences of the administration’s proposal and criticized the lack of collaboration with the industry prior to the rule proposal.
The Proposed Mandates: A Flawed Approach
The administration’s proposal introduces two key staffing requirements: a mandated minimum of 0.55 hours per patient day for registered nurses, 2.45 hours for nurse aides, and a 24/7 registered nurse (RN) requirement. While the goal of improving care standards is commendable, Parkinson highlighted two fundamental flaws that could undermine the entire policy.
The first major hurdle, according to Parkinson, is the severe shortage of skilled workers in the nursing home sector. He described the current situation as unprecedented, with over 100,000 workers leaving the profession and no signs of them returning. The idea of rehiring these lost workers and recruiting tens of thousands more seems daunting and unrealistic, especially considering the demographic challenges that indicate a continuous loss in the nursing profession.
The second critical flaw revolves around the lack of funding. Nursing homes, particularly those dependent on Medicaid, are already facing significant financial constraints. Independent studies consistently report negative margins for Medicaid-based skilled nursing facilities. Even the Biden administration’s own estimate acknowledges the substantial cost of implementing the proposed mandates, which is approximately $4 billion per year. However, Parkinson cautioned that this figure might be a conservative estimate, and nursing homes are ill-prepared to bear such a financial burden.
A Backward Approach to Policy Development
Parkinson also criticized the administration’s approach to policy development, stating that it was backward compared to past administrations. Instead of conducting comprehensive studies and consulting with healthcare providers before formulating a minimum staffing policy, the current administration announced its policy first and conducted analysis afterward. This unconventional approach resulted in a policy lacking a logical and practical foundation.
When asked about potential litigation, Parkinson indicated that AHCA/NCAL is primarily focused on dialogue with the administration and Congress at this time. He expressed hope that the rulemaking process or Congressional action could lead to positive changes in the proposed policy.
Comprehensive Analysis by CLA
The press conference included a presentation of findings from Clifton Larson and Allen (CLA), which conducted a thorough analysis to assess the potential impact of the proposed staffing mandates on nursing homes. The analysis looked at the 24/7 RN requirement proposal as well as hours per resident per day proposals and estimated the number of additional staff that would need to be hired.
According to CLA, nursing homes would need to hire approximately 102,154 additional full-time employees (FTEs) to meet the proposed staffing requirements, including 80,000 nurse aides and 22,000 registered nurses. The estimated cost of implementing the mandate stands at around $6.8 billion per year, potentially exceeding the administration’s projection.
Real-World Perspectives from Providers
Marie Costa, a provider from Northern Nevada, shed light on the challenges faced by nursing homes in the current labor market. She emphasized the difficulty of competing with higher-paying jobs in the region and highlighted the crucial role LPNs (Licensed Practical Nurses) play in the care team. Unfortunately, under the proposed mandate, LPN hours do not count, further complicating staffing issues. Costa stressed that the proposed staffing mandate would have severe consequences for seniors who rely on Medicaid, as nursing homes would struggle to attract and retain caregivers without adequate funding and support for workforce development.
Possible Solutions
In his closing remarks, Parkinson addressed several pressing issues and offered policy recommendations to mitigate concerns. These recommendations include counting LPNs either in the registered nurse or nurse aide category, extending the phase-in period for all requirements to five years, developing a funding mechanism to support the recruitment and retention of required staff, and addressing various intricacies in the policy that unfairly penalize facilities. He emphasized the necessity of addressing Medicaid’s limitations and suggested that Congress would need to secure adequate financial resources.
Parkinson concluded by reaffirming AHCA/NCAL’s commitment to constructive dialogue with the administration and their unwavering focus on ensuring the well-being of nursing home residents and the sustainability of the sector.
What are the financial implications for nursing homes if the proposed mandates for staffing levels are implemented?
Rovided for registered nurses and nurse aides.
The CLA analysis found that the proposed mandates would have significant financial implications for nursing homes. Based on their calculations, the additional costs associated with hiring and retaining sufficient staff to meet the requirements would result in negative financial impacts for the majority of nursing homes, particularly those that rely heavily on Medicaid funding.
Furthermore, the CLA analysis raised concerns about the feasibility of implementing the 24/7 RN requirement. The shortage of available registered nurses, combined with the financial strain on nursing homes, makes it highly challenging to meet this requirement without compromising other aspects of care.
In response to the criticisms and concerns voiced by nursing home groups and staff representatives, the Biden administration has expressed a willingness to engage in dialogue and make adjustments to the proposed mandates. The White House has emphasized that their goal is to improve the quality of care in nursing homes while ensuring the financial sustainability of these facilities.
It is clear that there is a need for collaboration between the administration and the healthcare industry to find a balanced solution that addresses the concerns raised by all stakeholders. The nursing home industry plays a crucial role in caring for vulnerable populations, and any policy changes should take into account the unique challenges faced by these facilities.
Moving forward, it is essential for all parties involved to engage in open and productive discussions to find common ground and develop guidelines that truly improve the healthcare provided in nursing homes. This will require a thorough understanding of the financial constraints faced by these facilities, as well as the need for sufficient staffing levels to ensure the safety and well-being of residents.
Ultimately, the proposed staffing level mandates have sparked a heated debate within the healthcare industry. While the Biden administration’s intentions to enhance the safety and quality of care in nursing homes are commendable, it is crucial to address the concerns raised by nursing home groups and staff representatives to ensure that any policy changes are both practical and effective.
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