News Digest: AHCA lobbies against potential minimum staffing regulations
There was a long run up between the 2022 announcement of the INTENTION to create minmium staffing regulations until the Sept 1, 2023 announcement of the ACTUAL Proposed Minimum Staffing rule. In that void, associations, providers, advocates, policy makers and the public provided loud and strongly held views on the impact of the rule.
The leading association of nursing homes – AHCA – took a primary role in lobbying against the proposed rule, its high costs (unfunded mandate) and the risk of causing widespread nursing home closures across the country. These arguments are detailed in the below articles and blogs.
AHCA warns White House about ‘one-size-fits all’ staffing mandate, offers 4-point plan of its own
The nation’s largest nursing home association stung the administration with its own words Monday when it sent the White House another letter arguing against a planned federal nursing home staffing mandate.
Such a proposal would be in direct opposition to what the same regulators said seven years ago when they warned that a “one-size-fits-all” rule would not result in better care, the American Health Care Association wrote.
The provider group also offered four recommendations the federal government could implement instead of a national staffing rule that could result in drastic, “unintended consequences.” The recommendations are well-known to close observers as proposals AHCA has also made previously in its reform plans.
Towhey, Jessica R. “AHCA Warns White House About ‘One-size-fits All’ Staffing Mandate, Offers 4-point Plan of Its Own.” McKnight’s Long-Term Care News, July 2023, www.mcknights.com/news/ahca-warns-white-house-about-one-size-fits-all-staffing-mandate-offers-4-point-plan-of-its-own.
AHCA to White House: Nursing home staffing mandate spells ‘disaster’
A federal nursing home staffing mandate would be “impossible to implement” and a “disaster,” especially for seniors on Medicaid, the American Health Care Association/National Center for Assisted Living warned in a letter sent to President Biden Tuesday.
President and CEO Mark Parkinson reiterated the association’s serious concerns regarding an expected federal staffing mandate, once again highlighting historic labor shortages and unabating financial pressures in a system primarily supported by government payers.
“If your administration imposes this mandate, more nursing homes will close, especially facilities that uniquely serve our most vulnerable,” Parkinson wrote. “Nursing homes that primarily care for residents on Medicaid won’t have the resources to recruit staff or pay for this mandate. Those facilities, as well as those who they serve and employ, will be hurt the most. To reiterate, this policy will have the opposite impact than intended. The unintended consequences will be numerous and damaging to the nation’s ability to serve seniors in need.”
Marselas, Kimberly. “AHCA to White House: Nursing Home Staffing Mandate Spells “Disaster.”” McKnight’s Long-Term Care News, 13 July 2023, www.mcknights.com/news/ahca-to-white-house-nursing-home-staffing-mandate-spells-disaster/. Accessed 2 Oct. 2023.
Minimum staffing requirements good idea in theory only: AHCA/NCAL
A federal nursing home minimum staffing mandate “sounds like a good idea, but in practice, it is not,” American Health Care Association / National Center for Assisted Living President and CEO Mark Parkinson told President Biden in a letter Tuesday.
The White House Office of Management and Budget on May 30 began a review of a rule drafted by the Centers for Medicare & Medicaid Services.
Mandated staffing minimums will lead to nursing home closures, according to Parkinson, who noted that more than 500 nursing homes already have shuttered their doors since 2022, “often due to an inability to find workers.”
“Nursing homes that primarily care for residents on Medicaid won’t have the resources to recruit staff or pay for this mandate,” Parkinson wrote. “Those facilities, as well as those who they serve and employ, will be hurt the most.”
July 13, 2023
Gaivin, Kathleen Steele. “Minimum Staffing Requirements Good Idea in Theory Only: AHCA/NCAL.” McKnight’s Senior Living, July 2023, www.mcknightsseniorliving.com/home/news/business-daily-news/minimum-staffing-requirements-good-idea-in-theory-only-ahca-ncal.
Advocates intensify behind-the-scenes efforts as staffing minimum stalls
While on-the-ground providers can do little but wait for a now-overdue staffing minimum to drop, the sector’s top advocates remain furiously at work in the nation’s capital, hoping to mitigate its potential impact.
The stalled staffing rule has put the Office of Management and Budget in the spotlight since the White House body began its wonky review process on May 30. OMB oversees regulatory measures from across the federal government, weighing proposals for economic, regulatory and other effects.
As of Thursday, it was reviewing 25 rules from the Department Health and Human Services, more than from any other department. But it’s the proposed Minimum Staffing Standards for Long-Term Care Facilities rule that is drawing LTC’s attention to the review process.
Now that the rule is out of the hands of its drafters at the Centers for Medicare & Medicaid Services, sector representatives have held meetings with OMB staff and others involved in promulgating the version that will be published for the public.
June 30, 2023
Marselas, Kimberly. “Advocates Intensify Behind-the-scenes Efforts as Staffing Minimum Stalls.” McKnight’s Long-Term Care News, June 2023, www.mcknights.com/news/advocates-intensify-behind-the-scenes-efforts-as-staffing-minimum-stalls.
‘Backed into a Corner’: Over 500 Nursing Home Providers Gather to Protest Looming Minimum Staffing Proposal
Nursing home industry leaders, more than 500 of whom gathered on Capitol Hill this week to influence workforce legislation, sounded alarms over the possibility of a minimum staffing rule at the conclusion of their meeting with policy makers Tuesday.
At a time when the industry is still reeling from the effects of massive worker shortages that were worsened during the pandemic, and as the sector lags other areas of health care in recovering from labor challenges, nursing home executives and advocacy group leaders said any minimum staffing measure would be punitive.
“[A staffing minimum] will make things worse. It will cause beds to shut down. It will cause wings to close, and unfortunately, it will accelerate the closures of nursing homes,” said Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). “I know that the folks that want to do this are well-intentioned, but the results will be the opposite of what they want. Seniors will not be benefited. They will be hurt because access will decline,” he said.
June 6, 2023
Siddiqi, Zahida. “‘Backed Into a Corner’: Over 500 Nursing Home Providers Gather to Protest Looming Minimum Staffing Proposal.” Skilled Nursing News, June 2023, skillednursingnews.com/2023/06/backed-into-a-corner-over-500-nursing-home-providers-gather-to-protest-looming-minimum-staffing-proposal.
AHCA prepared to sue over minimum staffing mandate
A top executive of the largest US nursing home trade association said Tuesday his group is prepared to take legal action if an upcoming federal staffing mandate proves to be overly prescriptive.
More than 500 members of the American Health Care Association/National Center for Assisted Living gathered here this week for meetings with their Congressional representatives. Most were asking for support in making sure the staffing rule, details of which have still not been made public, offers a reasonable chance of compliance.
But should it not, AHCA is gearing up to continue its public awareness campaign and behind-the-scenes efforts to find friendly lawmakers willing to pressure the Centers for Medicare & Medicaid Services on its final regulations. Ultimately, the association also could sue.
June 7, 2023
Marselas, Kimberly. “AHCA Prepared to Sue Over Minimum Staffing Mandate.” McKnight’s Long-Term Care News, June 2023, www.mcknights.com/news/ahca-prepared-to-sue-over-minimum-staffing-mandate.
In nursing homes we don’t trust
The juxtaposition could hardly be more jarring.
As this goes to press, the nursing home industry is anxiously waiting for the federal government to release a first-ever staffing mandate.
When that happens, operators will be under unprecedented pressure to fill every available position. It’s also safe to predict the field will need to rely more on a key labor source: workers born elsewhere.
Yet less than a month ago, the US State Department issued a visa freeze that will absolutely reduce that labor supply.
“Washington often means well, but sometimes the left hand isn’t talking to the right.” That’s how American Health Care Association President and CEO Mark Parkinson diplomatically described the contradiction in The Hill.
June 5, 2023
O’Connor, John. “In Nursing Homes We Don’t Trust.” McKnight’s Long-Term Care News, 5 Jun. 2023, www.mcknights.com/daily-editors-notes/in-nursing-homes-we-dont-trust.
On federal staffing minimum, providers need protections: AHCA’s Phil Fogg
Skilled nursing providers could support a federal minimum staffing rule that is funded and protects them from penalties if they make “best faith efforts” to hire, according to one of the nation’s top sector advocates.
Phil Fogg, board chairman of the American Health Care Association, said providers must be confident that they won’t be punished for not meeting what could be an impossible standard, given the current workforce challenges.
“You just can’t send a rule out and expect people to comply when there’s absolutely no chance of it because of the workforce shortages,” said Fogg, who is CEO of Consonus Healthcare & Marquis Companies.
May 24, 2023
Towhey, Jessica R. “On Federal Staffing Minimum, Providers Need Protections: AHCA’s Phil Fogg.” McKnight’s Long-Term Care News, May 2023, www.mcknights.com/news/on-federal-staffing-minimum-providers-need-protections-ahcas-phil-fogg.
AHCA’s CEO: Nursing Homes Must Prepare for ‘Massive’ Staffing Mandate Battle, Adapt to Managed Care ‘Mega-Trend’
Nursing homes are past the “nightmare” caused by Covid-19, but now are facing “a real business problem” that could be considerably worsened by the coming federal staffing mandate.
That’s according to Mark Parkinson, CEO and president of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). He spoke Tuesday of the urgent need to battle the staffing mandate even now, before the proposal drops.
Parkinson said labor shortages are still plaguing the nursing home industry even as other subsectors in health care have recovered, and any regulation that fails to account for this crisis will be disastrous as the industry remains short of more than 200,000 workers.
“We’re just not seeing [the worker shortage] recovered,” he said. “It is ridiculous to enforce a staffing mandate … when you’ve got this kind of data.”
The finalized rule will likely not be solidified until sometime in 2024, he predicted, and until then the battle to modify and “make this rule better” and even challenge it from being implemented is underway.
May 10, 2023
Siddiqi, Zahida. “AHCA’s CEO: Nursing Homes Must Prepare for ‘Massive’ Staffing Mandate Battle, Adapt to Managed Care ‘Mega-Trend.’” Skilled Nursing News, 10 May 2023, skillednursingnews.com/2023/05/ahcas-parkinson-snfs-must-prepare-for-massive-staffing-mandate-battle-adapt-to-managed-care-mega-trend.
Lawmakers, union attack AHCA’s opposition to nursing home staffing mandate
Two members of Congress joined national union leaders Thursday in accusing nursing home owners of diverting federal funds away from patient care in what was ostensibly a rally in support of a federal staffing mandate.
In calling on the Centers for Medicare & Medicaid Services to hasten its adoption of a first-ever national staffing minimum to support beleaguered frontline workers already in place, Rep. Jan Schakowsky (D-IL) also painted nursing home owners and their top advocacy organization, the American Health Care Association, as “the opposition.”
She said AHCA had spent $3.9 million lobbying Congress on the staffing mandate issue last year. AHCA leaders say they have embraced the idea of increasing staff, but they also have cautioned that mandating hiring when the sector remains down more than 200,000 workers from its pre-COVID levels could lead to disaster for some facilities.
April 21, 2023
Marselas, Kimberly. “Lawmakers, Union Attack AHCA’s Opposition to Nursing Home Staffing Mandate.” McKnight’s Long-Term Care News, 21 Apr. 2023, www.mcknights.com/news/lawmakers-union-attack-ahcas-opposition-to-nursing-home-staffing-mandate.
AHA, AHCA Issue Joint Letter to CMS Outlining Staffing Mandate Concerns
The American Hospital Association (AHA) and American Health Care Association (AHCA) sent a joint letter to the Centers for Medicare and Medicaid Services on Monday expressing their concerns about the proposed federal staffing mandate.
“We anticipate many nursing homes will be forced to further reduce their capacity and even close their doors if they are unable to meet these staffing mandates,” the letter stated. “This would accelerate the domino effect across the entire continuum of care and leave vulnerable seniors with fewer care options.”
“Furthermore, mandating staffing levels is a simplistic, one-size-fits-all approach to the needs of complex and unique nursing home residents and patients,” the letter stated. “In short, specific staffing levels should be a clinical decision customized to the resident population and facility characteristics rather than a policy decision made with lack of regard to real-life situations.”
April 4, 2023
HealthLeaders. “AHA, AHCA Issue Joint Letter to CMS Outlining Staffing Mandate Concerns.” HealthLeaders Media, www.healthleadersmedia.com/post-acute/aha-ahca-issue-joint-letter-cms-outlining-staffing-mandate-concerns.
Provider groups push back on planned nursing home staff mandates
Two major hospital groups are pushing back against the CMS’ plans this year to issue federal staffing minimums for nursing homes, according to a Monday letter sent to CMS Administrator Chiquita Brooks-LaSure from the American Hospital Association and American Health Care Association.
In the letter, the groups argue that federal staffing mandates are a “one-size-fits-all” approach to the labor crisis and that issuing mandates would further reduce capacity by forcing some nursing homes to shut their doors.
April 4, 2023
Mensik, Hailey. “Provider Groups Push Back on Planned Nursing Home Staff Mandates.” Healthcare Dive, 4 Apr. 2023, www.healthcaredive.com/news/federal-nursing-home-staffing-ratio-provider-group-AHA-oppose/646767.
Long-term care struggles to rebound to pre-pandemic staffing levels: analysis
Staffing in long-term care dropped drastically at the start of the pandemic and is unlikely to rebound to pre-pandemic levels until 2027. That’s according to a recent analysis of US Census data by the American Health Care Association / National Center for Assisted Living.
Another threat hampering skilled nursing’s rebound to pre-pandemic staffing levels, AHCA/NCAL said, is the federal government’s proposed staffing minimums. Almost all respondents (95%) to an association survey in December said that they were concerned about being able to meet a staffing minimum of 4.1 hours of care per day per resident being floated by the Centers for Medicare & Medicaid Services.
“Government staffing mandates will not solve the core issue here. We need a concerted, collective effort with proper resources and incentives to help recruit more individuals to work in long-term care,” Holly Harmon, RN, AHCA/NCAL’s senior vice president of quality, regulatory and clinical services, said in a statement issued in conjunction with the December survey results.
January 23, 2023
Gaivin, Kathleen Steele. “Long-term Care Struggles to Rebound to Pre-pandemic Staffing Levels: Analysis.” McKnight’s Senior Living, 23 Jan. 2023, www.mcknightsseniorliving.com/home/news/business-daily-news/long-term-care-struggles-to-rebound-to-pre-pandemic-staffing-levels-analysis.
Data Doesn’t Lie: Current Pace Sets Nursing Home Workforce Recovery Back to 2027
Year-end 2022 data puts the nursing home workforce shortage in “stark perspective,” as slow job growth is pitted against regulatory updates and looming staffing mandates.
That’s according to the American Health Care Association and National Center for Assisted Living (AHCA/NCAL). The aging services organization on Thursday released an analysis of data published by the Bureau of Labor Statistics (BLS).
“The data doesn’t lie,” Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement. “This is not just an exaggerated call for help, and this labor crisis will not go away on its own or through government enforcement.”
Parkinson refers to a potential federal staffing mandate due to be revealed in the coming months, along with a study from the Centers for Medicare & Medicaid Services (CMS). A federal government mandate will only worsen the staffing crisis, according to AHCA’s staffing analysis.
January 19, 2023
Stulick, Amy. “Data Doesn’t Lie: Current Pace Sets Nursing Home Workforce Recovery Back to 2027.” Skilled Nursing News, 19 Jan. 2023, skillednursingnews.com/2023/01/data-doesnt-lie-current-pace-sets-nursing-home-workforce-recovery-back-to-2027.
80% of Nursing Home Providers ‘Very Concerned’ About Possible Federal Staffing Mandate
A vast majority of nursing homes favor extending the public health emergency designation for Covid, and are concerned that they will be unable to meet a potential federal staffing minimum.
These views, expressed in a newly released survey by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), come in the midst of a labor shortage despite widespread wage increases and hiring of temporary workers.
AHCA’s survey shows that about 80% of nursing homes are very concerned that they will be unable to meet a potential federal staffing minimum of 4.1 hours per resident day (HPRD) due to a labor shortage, rising inflation and higher operating costs.
January 10, 2023
Siddiqi, Zahida. “80% of Nursing Home Providers ‘Very Concerned’ About Possible Federal Staffing Mandate.” Skilled Nursing News, 10 Jan. 2023, skillednursingnews.com/2023/01/80-of-nursing-home-providers-very-concerned-about-possible-federal-staffing-mandate.
Survey: Nursing Home Providers Say Workforce and Economic Challenges Persist
The American Health Care Association (AHCA), representing more than 14,000 nursing homes and other long term care facilities across the country, released a survey of more than 500 nursing home providers from across the U.S. highlighting how nearly three years into the COVID-19 pandemic, the industry continues to face a serious labor and economic crisis.
The survey findings also demonstrate how the crises are impacting access to care for vulnerable seniors and would make it impossible for the industry to meet increasing government staffing requirements without corresponding support.
Nearly all respondents (95 percent) were concerned about being able to meet a 4.1 HPRD staffing minimum, including 79 percent who were “very concerned.”
January 10, 2023
Survey: Nursing Home Providers Say Workforce and Economic Challenges Persist. www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Survey-Nursing-Home-Providers-Say-Workforce-and-Economic-Challenges-Persist.aspx.
Parkinson: Nursing home sector pinning hopes on ‘Medicaid adequacy’ rule
After characterizing business conditions as “never worse,” the skilled nursing sector’s top advocate said stakeholders need more help from both the federal and state governments to forge a viable path forward.
The solution could lie in the Centers for Medicare & Medicaid Services universally demanding that states prop up Medicaid payments, said Mark Parkinson, the president and CEO of the American Health Care Association/National Center for Assisted Living, during a media briefing Tuesday at the group’s annual meeting.
“CMS has talked about really putting some teeth into its authority to require states to pay an adequate amount of Medicaid — for all healthcare providers, not just skilled nursing facilities. In far too many states right now, the reimbursement for Medicaid is dramatically less than the actual cost of taking care of people in nursing facilities,” he said.
October 11, 2022
Berklan, James. “Parkinson: Nursing Home Sector Pinning Hopes on ‘Medicaid Adequacy’ Rule.” McKnight’s Long-Term Care News, 12 Oct. 2022, www.mcknights.com/news/parkinson-nursing-home-sector-pinning-hopes-on-medicaid-adequacy-rule.
Experts Question How Nursing Homes Will Pay For More Staff Amid Anticipated Minimum Staffing Mandate
The Biden administration is expected to issue a federal minimum staffing mandate for nursing homes. As the long term care sector continues to face a historic labor crisis, experts are questioning how the proposed mandate would address staffing shortages without resources or support.
Many providers have already increased pay and benefits, which has been invaluable for workers and enabled nursing homes to try to compete in today’s challenging job market. This raises serious questions about the ability of programs like Medicaid and Medicare Advantage to keep pace. The mandate could require an estimated $10 billion per year for caregivers’ wages and benefits – and so far, the proposed mandate remains unfunded.
Rather than unrealistic, unfunded mandates that will result in more nursing homes closing, policymakers should focus on meaningful solutions to attract more caregivers to the field.
October 7, 2022
Experts Question How Nursing Homes Will Pay for More Staff Amid Anticipated Minimum Staffing Mandate. https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Experts-Question-How-Nursing-Homes-Will-Pay-For-More-Staff-Amid-Anticipated-Minimum-Staffing-Mandate-.aspx
