September 28, 2023 Washington DC – In a letter sent to Congressional leaders today addressing the Centers for Medicare and Medicaid Services (CMS) September 1 proposed rule on nursing home staffing mandates, a top aging services executive urged policymakers to focus on advancing real solutions to ensure quality nursing home care for older adults and families across America. 

“We all want to ensure access to quality care for older adults, but federal leaders are getting it wrong right now,” said Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services, including nursing homes. “CMS’s proposed nursing home staffing mandate rule works against that shared goal, and would limit older adults’ and families’ access to care.”

The letter lays out three main reasons why the proposed rule will be impossible to implement: 

1. There is no funding to cover the $7.1 billion price tag of CMS’s proposed regulation.
2. The mandate would require 90,000 more workers, and there are simply not enough people to hire.
3. Mandating staffing requirements could decrease access to care across the continuum of care.

The letter asks Congress to intervene to delay the proposed rule until there are enough qualified applicants and adequate funding to address staffing levels. Sloan provides her association’s independent cost analysis of the proposed rule, which projects implementation would be at least $7.1 billion—far higher implementation than CMS estimates.

“The costs of delivering quality care already far exceed Medicaid reimbursement levels, and this unfunded mandate will force nursing homes to consider limiting admissions or even closing their doors for good, depriving older adults and their families of care in their communities.” the letter states. That outcome is the opposite of what providers, lawmakers, the administration and the American people want.

Nursing homes aren’t the only part of the healthcare system that will be affected if the rule is implemented as proposed. Home health providers are already rejecting referrals and some face closure due to financial pressures and workforce shortages. There will be far fewer options for older adults and families to access care, and communities of color and less affluent individuals will feel the deepest impact. 

“The current and highly fragmented approach to long-term care financing no longer serves the millions of older adults who require compassionate and highly skilled care,” writes Sloan, calling on Congress to work with the Administration on realistic solutions, including a “robust national workforce development strategy.” 

LeadingAge has put forward solutions to tackle the aging services workforce crisis in America including prioritizing immigration reform to help build the pipeline of workers; increasing funding and working with states to increase Medicaid reimbursement rates to cover the cost of care and increase wages; and replicating existing successful training programs and expand opportunities for interested applicants to pursue careers as RNs, LPNs and CNAs. 

“We need a holistic approach to real solutions to the workforce crisis. Let’s get this right,” said Sloan.