My association administers a long-term care foundation that has given over $1 million in scholarships to workers in New Hampshire long-term care facilities looking to pursue their dreams.  Put another way, this small foundation has given out over 1% of the $75 million the Biden Administration comically brags it will invest in the workforce needs of roughly 15,000 nursing homes across the United States.

There was a certain poignancy to last month’s annual scholarship dinner, because nine of the scholarship recipients were nursing assistants studying to become licensed practical nurses (LPNs) – a profession that doesn’t matter to the Biden Administration in its proposed staffing mandate rule for nursing homes.

I’m clueless as to why these caregiving heroes are irrelevant to the Administration.  Federal data shows that in 2022 there were 700 LPNs working in New Hampshire nursing homes, making an average of $31.72 an hour, versus 470 registered nurses.  It’s an honorable, good-paying profession.  And if McKinsey & Associates is right in having estimated that by 2025 “the United States may have a gap of between 200,000 to 450,000 nurses available for direct patient care” wouldn’t we want to value every nurse currently providing bedside care? 

Juxtapose this attempted regulatory erasure of LPNs with U.S. Health and Human Services Secretary Xavier Beccera’s nonsensical grandstanding in a Facebook event: “If you’re going to be a nursing home you better have a nurse in your employment.”  Just transcribing that statement made me dumber.   

Another of our scholarship recipients that wouldn’t matter to the Biden Administration has worked at the same rural nursing home for 42 years in a variety of roles, including nursing assistant, and is now its maintenance director.  He began work at the facility when his grandmother was a resident, as he wanted her to have family close to her.  But because he’s not working as a nursing assistant or a registered nurse (RNs) his love for, and dedication to, long-term care would be immaterial to the proposed mandate.

Instead, that same facility, in a town of 3,218 that is the second biggest in its sprawling rural county, will have to find more registered nurses and nursing assistants.  Good luck with that.

Surely continuity, and quality, of care matters as much as the quantity of caregivers.  In fact, that was the finding of a Journal of the American Medical Association study synopsis reported Oct. 9.  I bought the article to dig deeper.  The findings may seem obvious to all but the more-bodies-equals-better-care crowd at the Centers for Medicare & Medicaid Services (CMS): “High rates of staff turnover may reduce care quality by disrupting continuity of care; inhibiting the formation of relationships between residents and staff, which are important to the delivery of person-centered care; and limiting the acquisition of skills and institutional knowledge through on-the-job experience.” 

Thus, retaining staff, and to me that goes beyond just direct care, is as important as adding to it.  And if retaining staff is an important goal, we might ask how that goal could possibly be achieved if a mandate piles an unfunded annual cost of between $4.06 billion (the CMS estimate) to $6.8 billion (the CliftonLarsonAllen LLP estimate) upon nursing homes. 

The CMS bean-counters are only counting beans, not quality or tenure.  No New Hampshire facility not currently meeting the proposed staffing ratios has reported it would be able to hire the staff to do so.  Instead, the minority of facilities that would not simply deny admissions to improve their staffing ratios would be forced to use nurse staffing agencies, which could only demoralize their existing caregivers and, perhaps, inspire them to jump ship to agencies.  How would this Staffing Agency Enrichment Rule – to call it what it truly is – serve “continuity of care” or assist “the formation of relationships between residents and staff”?

What more empirical evidence do we need to prove this proposed mandate is an utter fraud masquerading as a fix? 

Brendan Williams is the president & CEO of the New Hampshire Health Care Association.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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