John O'Connor
John O’Connor

It’s probably safe to say very few long-term care operators want to see staffing mandates.

But the time has come to face an unpleasant truth: They are coming. Possibly, any day now. How can we make this prediction? Because the Centers for Medicare & Medicaid Services has said they are on the way.

In fact, the only real surprise in this ongoing saga is that they continue to be delayed. Many industry observers expected the requirement to appear in last week’s rate hike announcement. So a bullet of sorts was dodged. But it would be unwise to confuse a delay with a reprieve.

 As for why the requirement was held back? More than likely, CMS is still trying to work out some staffing-related kinks. After all, the mandate promises to be a real game changer.

For now, that leaves operators in a purgatorial state. They know all too well that what’s coming will hurt, they just don’t know how much. Either way, there will be pain.

And the timing could hardly be worse.

Operators have just endured more than three years of COVID-19, which has been one of the greatest job disincentive programs ever created for long-term care.

Hiring and keeping capable workers is a major challenge in the best of times. And what operators have experienced lately is anything but.

So, facilities that can’t find enough workers are going to be forced to meet quotas? To say the logic here is a bit odd would be an extreme understatement. It’s like hiring jockeys based on their vertical leap.

Do I sound as if I am opposed to staffing requirements on their own merits? I’m not. But neither am I a fan of two hurtful things:

One is beating down a person or institution that’s already beaten down. Nursing homes have shown time and time again that given existing market conditions, they cannot fully staff. Frankly, all a quota will likely do is give regulators another tool by which to punish.

Another pet peeve is unfunded mandates. And by all indications, CMS is not going to be setting aside sufficient funds for hiring and retaining enough people. 

How can we make this second prediction? In a word, precedent. The regulatory history of long-term care is chock full of rules and requirements that arrived with inadequate funding support — or none at all.

My trifling concerns aside, we all know what’s ahead. Staffing mandates will arrive, along with promises of better care as a result.

But there’s a better way to describe this looming innovation: doomed from the start.

 John O’Connor is editorial director for McKnight’s.

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