As planned CMS staffing ratios near, nonprofit nursing homes offer a realistic approach to staffing in the current workforce crisis.

As part of the Biden Administration’s nursing home care initiative, the Centers for Medicare & Medicaid Services (CMS) is poised to impose staffing ratios. For the first time in decades, our federal government is committed to meaningful action to ensure America’s older adults and families can receive quality nursing home care—a goal that LeadingAge and its nonprofit, mission-driven nursing homes have long shared. But at a time when providers are operating under severe workforce shortages ​​and inadequate reimbursement, staffing mandates will undoubtedly force closures and limit older adults and families’ access to care and services. 

To ensure that federal action is realistic and can achieve its intended effect, LeadingAge proposes a new framework and perspective for federal legislation concerning staffing ratios in nursing homes.

Our Proposal

LeadingAge calls for federal legislation to address the issue of nursing home staffing ratios within the reality of the current staffing and funding crisis. Our proposal establishes six common sense conditions that must be met before mandatory nursing home staffing ratios could be implemented:

1. The Medicaid fee for service nursing home rate covers at least 95% of the cost of care.
2. States with Medicaid Managed Long-Term Services and Supports have a set benchmark rate equal to at least 95% of the cost of care.
3. The secretaries of Labor and Health and Human Services have certified there is not a shortage of potential employees qualified to work in long-term care settings.
4. Standards are  flexible enough to meet the current needs of the residents being served. 
5. A national public health emergency is not in place. 
6. Staffing ratio mandates include waivers for local emergency conditions in place.

The Critical Issues

• There are too few people available to hire in nursing homes. Like much of health care and other sectors of the economy (there are currently nearly two jobs for every job seeker), nursing homes are struggling with employee shortages—on top of a chronic workforce crisis marked by significant challenges in recruiting, training and retaining qualified care professionals.
• The cost of delivering quality nursing home care far exceeds reimbursement. Nursing homes largely rely on Medicaid for most of their financing. Unlike other businesses, they cannot simply charge consumers more. Average Medicaid base rates across states covered just 86% of nursing home costs in 2019—and that was before pandemic costs and inflation were a factor. Providers are largely dependent on reimbursement to cover the cost of delivering quality care. Without it, they can’t survive.  
• One staffing level does not fit all needs. The needs and underlying condition of nursing home residents nationwide vary widely—as do the skills and capacity of available care professionals, each location’s operational capabilities, and local workforce conditions.

LeadingAge stands ready to collaborate with Congress and the Administration on behalf of our members, and look forward to continuing the ongoing discussion of how to ensure quality nursing home care to older Americans and their families.