November 7, 2023

Proposed nursing home staffing mandate would hurt senior living providers ‘fishing from the same pool’ of workers

McKnights Senior Living

CHICAGO — Even though the staffing mandate proposed by the Centers for Medicare & Medicaid Services directly would apply only to nursing homes, senior living providers as well as providers across the rest of the aging services continuum would be affected because they are “fishing from the same pool” of workers, LeadingAge President and CEO Katie Smith Sloan said Monday.

The bottom line, she said, speaking at the opening session of the LeadingAge Annual Meeting, is that the proposal simply is not viable. “There are just not enough people to hire,” Sloan said.

The CEO said that the proposed standard for nursing homes, as written, would require 90,000 additional nurses and nurse aides at a cost of approximately $7.1 billion annually.

“We know the impact of such mandates have a ripple effect across the whole entire aging services sectors,” she said, adding that “assisted living residents in need of a higher level of care may have to do without, and older adults in independent living seeking intermittent care will not get that support.”

“Shuffling workers among different settings will not work,” Sloan said. “Getting it wrong will undercut equity, access and care across the spectrum of aging services.”

With almost 42,000 comments received and posted from providers and consumers as of Monday morning, including 450 people who submitted comments from the LeadingAge meeting on Sunday — the deadline for comments was midnight Monday — Sloan said in a meeting with McKnight’s Senior Living, McKnight’s Long-Term Care News and McKnight’s Home Care that she never had seen providers so engaged in an issue as this one.

“What this issue is doing is sort of galvanizing our senior living, nursing home community, I think, in a really important way, and really thinking about, ‘What is quality? What does it take to get to quality?” she said.

“In a sense, we’re all fishing from the same pool [for workers]. We’re all looking for employees,” Sloan said. “Every part of the continuum is facing staffing shortages. Sometimes those are personal care aides, nurse aides, nurses, for sure. …For assisted living, you need nursing assistants and personal care aides. So as we tighten the pool and drive more staff to nursing homes to meet whatever the standard may be, you’ve got to get these folks from someplace, unless we figure out a way to broaden the pipeline through immigration or other channels.”

It’ll take CMS “a heck of a long time” to go through all of the comments, she predicted. “They have to read all of them, and that’s going to take months and months and months” and will involve reconciling “very, very, very divergent opinions,” Sloan said, predicting that it will be more than a year before CMS issues a final rule and noting, however, that proposed rules don’t have to be finalized.

Mandate ‘potentially devastating’

Argentum joined a coalition of senior living industry stakeholders — including AMDA–The Society for Post-Acute and Long-Term Care Medicine, the American Seniors Housing Association, the National Center for Assisted Living, LeadingAge, the American Assisted Living Nurses Association, the Association of Jewish Aging Services and Lutheran Services in America — to submit public comments on how the proposed rule would have “potentially devastating impact” on the long-term care industry.

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