The federal mandate for nursing home staffing will pull workers out of senior living facilities, groups fear

A federal mandate for nursing home staffing will siphon workers from assisted living facilities and other long-term care facilities, limiting access to care and services in the long run, according to senior living experts responding to the release of the final rule Monday.

A White House statement on the rule, which only directly applies to Medicare and Medicaid certified nursing facilities, indicates that nursing homes must provide 3.48 hours of direct care per patient/resident per day. The rule also maintains a requirement proposed last fall that facilities must have a registered nurse on site at all times. However, the unveiling of the 329-page final rule on Monday afternoon revealed that the Centers for Medicare & Medicaid Services would exempt nursing homes from RN coverage for up to eight of the 24 hours a day “under certain circumstances.”

The new requirements “appropriately prioritize the quality and safety of care achieved by establishing minimum standards for nursing staff,” CMS said.

Katie Smith Sloan, president and CEO of LeadingAge, said the association shares the agency’s goal of ensuring quality care.

“For the first time in decades, our federal government is committed to meaningful action to ensure that America’s older adults and families can receive much-needed quality care wherever they live, whether in nursing homes or in their homes and communities ” she said in a statement. . “LeadingAge and our nonprofit, mission-driven senior care providers, who serve both nursing home seniors and independently living seniors – in their own homes, assisted living and federally assisted housing – share the administration’s purpose.”

However, the association is concerned, especially because workers are needed across the continuum, she said.

“Two key issues – the lack of qualified candidates and the costs of recruiting and training staff – mean that implementation of the final rule for nursing homes will likely limit older adults’ and families’ access to care and services,” Sloan said.

The American Seniors Housing Association said everyone, including CMS officials, knows there is a serious workforce shortage across the long-term care continuum.

“A federal mandate to hire more workers will not create more workers,” Jeanne McGlynn Delgado, ASHA Vice President of Government Affairs, told me. McKnight’s Senior Living. “And without additional funding to subsidize this new requirement, this ensures the system cannot fail.”

Providers are still recovering from COVID-19 losses, including the loss of employees who have retired, changed occupations or simply left the workforce. The industry, she added, is stepping up on wage increases, flexibility and benefits and must be allowed to fully recover before mandates are imposed that cannot be met in the current undersupply environment.

Delgado, Sloan and others at industry associations had previously pointed out that a hiring mandate for part of the continuum would impact other types of providers because all providers recruit from the same pool of employees.

Similarly, LaShuan Bethea, executive director of the National Center for Assisted Living, previously said the nursing home staffing mandate would put assisted living communities at risk of losing staff.

“Many assisted living providers continue to experience staffing shortages, while others have reduced their workforces nearly to pre-pandemic staffing levels,” Bethea said. “No matter where an assisted living community falls on this continuum, a federal minimum staffing mandate threatens to take away the essential workforce these communities depend on to provide high-quality care to hundreds of thousands of residents.”

LeadingAge, ASHA, NCAL and Argentum were part of a coalition of senior living stakeholders – which also included AMDA – The Society for Post-Acute and Long-Term Care Medicine, the American Assisted Living Nurses Association, the Association of Jewish Aging Services and Lutheran Services in America – submitted public comments last fall on how the proposed rule would have “potentially devastating consequences” for the long-term care industry.

An Argentum white paper released last month reiterated the need to create more than 3 million new jobs in the seniors sector by 2040 to care for America’s rapidly aging population.

The future of the minimum staff rule remains to be seen.

“This fight is not over,” Mark Parkinson, president of the American Health Care Association/NCAL, said Monday.

Active bills in both houses of Congress could block the staffing rule, and at least one provider group has said it could sue to thwart the adoption if the final rule is unworkable.