- Sens. Kevin Cramer, D-N.D., and Angus King Jr., I-Maine, sent a letter to CMS Administrator Chiquita Brooks-LaSure on Thursday, asking the agency to withhold its controversial staffing mandate for long-term care facilities.
- The CMS proposal issued last month would require nursing facilities, including veterans homes, to have at least one registered nurse on duty at all times and provide three hours of care per resident, per day, with 0.55 hours coming from registered nurses. An analysis from KFF last month found 81% of nursing facilities nationwide would need to hire additional staff to meet the requirements.
- In the letter, the senators warned that many markets, including their home states, may not have enough nurses to meet requirements, which could cause some long-term care facilities to close and disrupt care for veterans.
The CMS and HHS introduced the proposed staffing minimums after the COVID-19 pandemic shone a light on quality problems in the long-term care industry.
Currently, the Nursing Home Reform Act of 1987 requires homes to have “sufficient” staffing, but lacks guidance on how states ought to interpret that standard.
The proposed law would be the first to mandate specified ratios. President Joe Biden promised to establish staffing minimums when he introduced the Action Plan for Nursing Home Reform during the State of the Union address last year.
The senators, who are both members of the Senate Veterans Affairs Committee, urged the CMS to rescind or significantly revise the proposed staffing mandate, calling for more consideration of other nursing staff, rural facilities and exemption criteria.
“While we share the agency’s desire to advance policies aimed at improving quality of care for seniors, our rural nursing facilities have limited options to address the lack of clinical staff available in their localities, and the proposed rule will exacerbate the problem,” the senators wrote.
In their home states, nurse staffing shortages have already led to care disruptions. In 2022, 50% of nursing facilities in North Dakota halted admissions due to a lack of staff, according to a report from a lobbying association representing the state’s long term care facilities. Over the course of the pandemic, facilities lost 15% of their staff, many of which never returned, according to the North Dakota Long-Term Care Association.
In Maine, staffing levels at nursing facilities declined 14.2% between February 2020 and December 2022, and Maine’s Veterans’ Homes currently have over 160 vacant positions, representing 16% of their positions, according to the letter.
“Issuing mandatory staffing requirements would be impossible to fill and add destructive costs to their operating budgets,” the senators said.
The senators are not the first to criticize the proposal. The American Health Care Association, which represents over 14,000 skilled nursing facilities and assisted living centers, issued a statement last month arguing the new policy would require homes to “hire tens of thousands of nurses that are simply not there.” In an analysis of the proposed rule, the AHCA said implementing the standard would cost nursing homes approximately $6.8 billion per year.
Other lobbying groups argue the proposal does not go far enough to ensure quality of care. The Long Term Care Community Coalition, a nonprofit advocacy group for long-term care residents, pointed to a landmark 2001 CMS study that called for 4.1 nurse hours per resident day. The coalition also projects the costs of implementing the proposed 24/7 RN requirement as low as roughly a dollar a day.
The senators also called for Licensed Practical Nurses — who undergo less training than RNs — to count toward staffing minimums, asked the CMS to revise its definition of rural facilities and review exemption criteria based on a long-term care facility’s proximity to other facilities.
The comment period on the proposed rule is open through Nov. 6.