Conventional wisdom says that nothing happens in Washington without a lot of people knowing about it first.

No matter what a legislative, executive or even judicial decision may be, many eyes and minds are first exposed to it before it becomes public.

The only real question seems to be how broad that circle of knowledgeable people may be. In the case of the long-term care story of the year, it’s not been wide at all, to hear nursing home leaders tell it.

That story, of course, is the White House’s promised first-ever federal staffing mandate for nursing homes. Yet another week came and went without the much-awaited unveiling announcement. 

National provider leaders said again this week they have had no indications from federal officials as to what’s ahead. All the latter have said is that an announcement will come “this spring.” Last week, Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure doubled down on that by emphasizing that she likes to hit her deadlines.

As I pointed out a little more than a month ago, however, spring technically doesn’t end until June 21. So nerves may continue to further fray for about another six weeks if the feds really want to push this to the limit.

And frazzled they already are. While protesting the prospect of a potentially unfunded mandate to anyone who will listen, Mark Parkinson, the president and CEO of the American Health Care Association, also is assuring his members that there is no way the mandate isn’t going to happen. The big question seems to be how hard and fast it will come.

The hope inside AHCA is that an announcement doesn’t occur until well into June, or some other “late” date that would make it impossible to implement a new system by Jan. 1, 2024. That could buy as much as another 12 months’ time. The big prize then could be that a different administration might be on its way into the White House, and that could mean a whole new ballgame.

Regardless of whether there may be regime change, regulators are going to have to phase in whatever they propose in a staffing mandate. There will not be a date circled on the calendar, after which all nursing homes must have “X” number of nurse hours per resident day or otherwise be subject to fines or other punishment.

The educated guess is there’s some kind of disagreement between aggressive White House officials and overseers at CMS, who may be a little more circumspect as the managers who actually have to make any mandate work.

This could be an instance where CMS’ more intimate knowledge of the nursing home sector could actually come in handy for providers. CMS as inadvertent operator protector? Crazier things have happened.

Providers can only hope that their lobbying efforts to show how many facilities have shut down and how many provider services have been scaled back due to staff shortages are having an effect. The CMS mission, after all, is to ensure broad access to healthcare services to Americans. It can’t be heartened by the beds that have been taken out of commission, particularly in rural areas. One thing’s for sure: Services aren’t being diminished because of a lack of prospective patients.

So as CMS and the White House ponder their next steps, they have to be careful with their staffing mandate. There’s the image of Old West plainsman or soldier laying an ear to the ground to try to figure out where a herd of buffalo or horses may be roaming. 

The trick for officials now is not to get caught trying to discern how bad circumstances may be, with their ear to the ground as it were, even as a thundering herd stampedes toward them.

James M. Berklan is McKnight’s Executive Editor.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.