Federal Staffing Mandate Could Kick 300,000 Out of Nursing Homes

September 26, 2023

  • Trade group pegs proposal’s cost at $6.8 billion
  • Would require hiring of over 100,000 additional staff

Nursing homes could be forced to drop over 280,000 residents to comply with the Biden administration’s proposed minimum staffing requirements unless Congress provides more funding, a trade group says.

The American Health Care Association’s analysis released Tuesday found that the proposed mandate (RIN 0938–AV25) released by the Centers for Medicare & Medicaid Services on Sept. 1 could require facilities to hire over 100,000 additional nurses and nurse’s aides at an annual cost of$6.8 billion.

Nursing homes that care for low-income residents on Medicare and Medicaid would either have to downsize or shut down without additional resources from the government to fund the expansion, Cory Rutledge, chief assurance officer at Clifton Larson Allen LLP, a professional services firm that ran the study, said.

“Unfortunately as we sit here today, about 60% of the profession is currently operating in the red. Nursing homes are faced with increased operating costs while still struggling to rebuild their workforce and occupancy rates to pre-pandemic levels. If we can’t find the additional staff, the only thing to do is discharge residents,” Rutledge said.

Federal law requires nursing homes to provide “licensed nursing services” that are “sufficient” to meet resident needs. Medicare regulations currently only require nursing homes to have at least one registered nurse on duty for eight straight hours per day.

The proposed rule would increase the on-site RN staffing requirement to 24 hours while also mandating nursing homes to provide 2.45 hours of care per resident day from nurse aides and 0.55 hours per resident day from registered nurses, something that AHCA President Mark Parkinson said would be unfeasible.

“The workforce is simply not there. We’re well over 100,000 workers who have simply left our profession and have not returned. To think that we could somehow get them back and then add more than 100,000 additional workers is simply not realistic,” said Parkinson.

Rural nursing homes and communities may be hit hardest by the federal mandate. Recent surveys from the AHCA found two-thirds of rural facilities were concerned about closure due to staff shortages, which the proposed requirements could accelerate, according to the AHCA.

Parkinson said the only way a staffing expansion could work in the future is by increasing Medicaid funding to low-income nursing homes, something that would take congressional approval.

“The facilities that really need help with staffing are the Medicaid facilities, so there needs to be some sort of a change to Medicaid. It would require either Congress to act—because obviously, CMS cannot raise funds itself—so Congress would [need to agree] to fund the increased cost. Or, CMS [would need to force] states to pay an adequate Medicaid rate before they approve the state’s Medicaid plans,” Parkinson said.

“So the question is, ‘Can CMS force states to pay additional amounts to providers in order to meet this requirement?’ That’s the only way that we really see that this can work,” he said.

Read the article from Bloomberg Law here.