Maine has the nation’s oldest population, and yet almost 40% of its nursing homes have closed within the past few decades.  As the Bangor Daily News has reported, that’s forced residents of some communities to travel “roughly an hour and a half” to the nearest facility for care.

Montana reportedly saw one-fifth of its nursing homes close in 2022 alone, and the Biden Administration’s proposed nursing home staffing mandate threatens those that remain, including, according to one report, the Crow Tribe’s Awe Kualawaache Care Center. 

Amidst enormous adversity, and despite President Biden’s sweeping generalizations about nursing homes – including alleging they’re “padding profits on the backs of residents and nurses” – the empirical evidence is that no other care sector has worked harder to try to recruit and retain staff since the COVID-19 pandemic began.

A December 2023 report found those working in nursing homes had “seen the highest average wage increases” in all of healthcare, as “average earnings rose by 24.9% between February 2020 and September 2023, from $671 to $839 per week.”  Comparatively, the report found that “offices of physicians which saw the largest rise in employment following the pandemic have seen the lowest average wage increases.”

The most regulated industry in America

Yet it’s nursing homes that get singled out for attack.  Our nation’s top health official, Secretary Xavier Beccera of the U.S. Department of Health and Human Services, has even been quoted saying, “the industry hasn’t had to follow particular standards” and decrying “the wild, wild west when it comes to quality and accountability at nursing homes throughout the country.”

Hmm, no “particular standards,” Mr. Secretary?  When the Nursing Home Reform Act was incorporated into the Omnibus Budget Reconciliation Act of 1987, the New York Times reported it was “written in extraordinary detail, like an agency regulation.”  And that is quite apart from the resulting regulations themselves.  For bedtime reading, I would suggest to Secretary Beccera Title 42, Part 483 of the Code of Federal Regulations.

As the Center for Medicare & Medicaid Services (CMS) noted in the agency’s 2016 rulemaking, “Commenters . . . claimed that LTC facilities are ‘the most regulated industry in America,’ and that ‘the nuclear industry is less regulated’ than the LTC facility industry.”

That wasn’t just hyperbole.  As of Feb. 3, 2023, the CMS State Operations Manual for nursing home surveys is 530 pages in length and will balloon further if the Biden regulatory regime goes into effect.  In contrast, the Handbook for Regulatory Inspectors of Nuclear Power Plants from the International Atomic Energy Agency, which the United States is a member of, is 114 pages in length as of its 2019 publication.

Beyond the staffing mandate

And the piling on doesn’t stop at the staffing mandate proposal.  While data shows that since 2013 more Medicaid long-term care funding has gone to home and community-based care than to nursing homes (a rebalancing I don’t begrudge), the Biden Administration publicly expects only nursing homes to overcome societal resistance to getting the latest COVID-19 shot – even though research found those 65-and-older in Medicaid HCBS had a greater COVID-19 mortality rate in that most tragic of years: 2020.

It was President Biden himself who declared the COVID-19 pandemic to be over, a declaration health experts correctly predicted would make it harder to persuade people to get new boosters.  How are nursing homes responsible for this?

Returning to where I began: It may not matter to President Biden that Hancock County, Maine, is expected to soon have no nursing home, just as it may not matter to him if the 2.2. million-acre Crow Indian Reservation loses its facility due to his unfunded staffing mandate.  But to the average nursing home, the mission of care is all-important, and I resent those who would question and undermine that commitment to score political points.

Brendan Williams is the president and 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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