February 16, 2023 Washington, DC – As the COVID public health emergency is set to expire, Katie Smith Sloan, president and CEO of LeadingAge, released the following statement about letters sent this week to Congressional leaders and Secretary of Health and Human Services Xavier Becerra calling for the federal government to eliminate the three-day qualifying hospital stay requirement for skilled nursing care.

“During the COVID-19 pandemic, it became clear that requiring a mandatory, three-day hospital stay for everyone who is ready to enter a nursing home is wasteful and ineffective. As the public health emergency expires, we urge the Department of Health and Human Services to immediately make permanent the waiver of the 3-day requirement, and we urge Congress to do away with the requirement entirely.

In the more than half-century since the requirement was adopted, a growing body of evidence and experience has proven that automatically requiring a three-day inpatient hospital stay is unreasonable, unnecessary, irresponsible and inequitable.  

• Unreasonable: The reality is that much of the routine care that’s offered to patients preparing to move to a nursing home can be provided in skilled nursing homes. At the same time, workforce shortages have become a top challenge across the health care sector. These real-world practicalities make mandatory stays unreasonable.
• Unnecessary: Audits conducted by the Medicare Administrative Contractors since the 2020 Covid waiver showed that the three-day stay isn’t needed to prevent inappropriate admissions—and that waiving the requirement had no negative impact on patient outcomes. This is evidence that the three-day stay doesn’t add any benefits to health care providers or patients.
• Irresponsible: The cumulative cost of requiring unneeded three-day stays is millions of dollars in unnecessary health expenses. The federal government must exercise good stewardship of health care spending and eliminate this wastefulness.
• Inequitable: On top of everything else, the three-day stay has been shown to negatively impact people living in disadvantaged neighborhoods. What’s more, lengthening hospital stays can be challenging for older people—especially those with cognitive impairments. These inequities, created by the current requirement, should be removed immediately. 

We represent more than 5,000 nonprofit aging services providers and other mission-minded organizations that touch millions of lives every day. Alongside our members and 38 state partners, we use applied research, advocacy, education, and community-building to make America a better place to grow old. Our membership, which now includes the providers of the Visiting Nurse Associations of America, encompasses the continuum of services for people as they age, including those with disabilities. 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.