April 22, 2024 Washington, DC — Statement from Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit, mission-driven providers of aging services, on the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting rule, made final today:
“LeadingAge and our nonprofit, mission-driven aging services providers, including nursing homes, share the Biden Administration’s goal of ensuring that America’s older adults and families receive quality nursing home care. Now more than ever, as America’s population ages and demand for care and services is growing, nursing homes are a critical element in our country’s long-term care continuum. Without the nurse aides, the registered nurses, licensed practical nurses and other caregivers who serve nursing home residents, there is no care.
Quality care and staffing are tightly connected. Workforce is a critical issue. Our nonprofit, mission-driven members prioritize recruiting, training and retaining quality staff. But for a number of reasons, the final rule announced today, while well intentioned, will not achieve the sought-after goals. Two major issues – the ongoing workforce shortage and cost of recruiting, training and retaining staff – mean that implementation could very well have unintended consequences and limit older adults and families’ access to care and services.
Consider this: There are not enough nurses in the United States to fill the positions that are currently open, and schools are not graduating enough nurses to fill either existing open jobs or those that are projected to open. RNs are leaving the workforce, leaving the profession and those who are working typically choose to work in environments that are not long-term care. The final rule does not include additional funds to pay RNs comparable or higher wages to work in long-term care. The implementation of a 24/7 RN would mean an additional 3267 additional RNs are needed.
The final rule does not include any support for recruitment and training of needed staff. While the phase in provides some necessary time for recruiting, how can providers hire more RNs when they do not exist?
Nurse aides, who are the backbone of aging services, are also in short supply – yet again, the rule does not include support to recruit, train and hire more of these critical workers. By the Centers for Medicare and Medicaid Services’ (CMS) estimate, the rule will add to providers’ financial burden – by $43 billion, over 10 years.
Funding goes hand in hand with quality care. Care costs money, but Medicaid reimbursements, which provide the lion’s share of nursing homes’ funding, do not fully cover the cost of providing quality care. Regulations and enforcement, even with the best intentions, just can’t change that math.
Sadly, this rule’s outcome may well exacerbate existing issues older adults and families face in trying to access nursing home care: limited admissions, fewer beds, and, worse yet, nursing home closures.
It’s time for the Biden Administration and Congress to dedicate real resources and devise meaningful solutions to fix long-term care’s workforce needs. America’s broken approach to funding and delivering long-term care and services must be addressed, starting with building and supporting the long-term care workforce.”
The issues that must be addressed and policy actions that need to be taken include:
Mismatched Reimbursement Mechanisms
Recommendation: Congress should pass the following bills to stop proposed payment cuts and address inadequate reimbursement mechanisms: Preserving Access to Home Health Act of 2023 (S.2137 / H.R. 5159), HCBS Relief Act (S.311 / H.R. 6267), Better Care Better Jobs Act (S.100 / H.R. 4131), Expanding Veterans’ Options for Long Term Care Act (S.465 / H.R. 1815) and the Expanding Service Coordinators Act (H.R. 5177).
Education and Training
Recommendation: Congress should pass the following bills to expand the nurse educator workforce – the Train More Nurses Act (S. 2853) and the Palliative Care and Hospice Education and Training Act (PCHETA) (S.2243).
Discordant Federal and State Training Requirements
Recommendation: Congress should consider developing and streamlining federal training requirements for direct care professionals and nurses. This should include an exploration of how Licensed Vocational/Practical Nurses (LVN/LPN) and experienced direct care professionals can assume increased training responsibilities for professional caregivers. This should be done with a focus on developing stackable certifications and opening pathways for aging services staff to engage in a lifetime of career development and learning.
Limited Clinical Training Sites
Recommendation: Congress should enact the bipartisan Ensuring Seniors’ Access to Quality Care Act that would eliminate the rigid provisions found in the Omnibus Budget Reconciliation Act of 1987 (OBRA) and grant the Centers for Medicare and Medicare Services (CMS) greater flexibility in reinstating valuable CNA training programs.
Supported Pathways and Services
Recommendation: In addition to the targeted federal medical assistance percentage (FMAP) increase, we urge Congress to increase reimbursement to allow providers to respond to the unique needs of their workforce. This should include providing support services and emergency assistance to staff, on an as needed basis, to increase recruitment and retention. To address shortages across the aging services continuum, we encourage Congress to pass the Supporting Our Direct Care Workforce and Family Caregivers Act (S. 1298).
Immigration
Recommendations: Congress should pass legislation that addresses critical gaps in the U.S. immigration system, including significantly increasing caps on employment-based visa programs, prioritizing nurses, and caregiving professionals. We urge Congress to pass the following bills to expand immigration pathways and increase supports for immigrants working in the aging services sector: Asylum Seeker Work Authorization Act (H.R. 1325), Assisting Seekers in Pursuit of Integration and Rapid Employment (ASPIRE) Act (H.R. 4309 / S. 2175), Healthcare Workforce Resilience Act (S. 3211), Leave No Americans Behind Act (H.R. 6205), and the Immigrants in Nursing and Allied Health Act (H.R. 3731).We represent more than 5,400 nonprofit and mission-driven aging services providers and other organizations that touch millions of lives every day. Alongside our members and 36 partners in 41 states, we use advocacy, education, applied research, and community-building to make America a better place to grow old. Our membership encompasses the entire continuum of aging services, including skilled nursing, assisted living, memory care, affordable housing, retirement communities, adult day programs, community-based services, hospice, and home-based care. We bring together the most inventive minds in the field to lead and innovate solutions that support older adults wherever they call home. For more information visit leadingage.org.
