John O'Connor

We’ve been hearing a lot lately about problems uninsured people are having with health exchanges. But not much is being reported about a different kind of exchange many long-term care managers might soon be dealing with.

Specifically, many schedulers will soon need to figure out how to make sure frontline workers who used to put in 40 or more hours each week don’t work more than 29.

Why would you want to trim hours in a field beset by chronic understaffing? Actually, there are millions of reasons. As in, it might cost long-term care millions of additional dollars if you don’t.

Like many perverse incentives, this one arrived on the shoulders of good intentions. The new health law’s architects wanted to target the nation’s uninsured workforce. To do so, they included a provision that requires firms with 50 or more employees to offer health benefits, provided the workers are on the job for at least 30 hours. The out for long-term care employers? Schedule workers for 29 hours or less.

By all indications, that’s exactly what many facilities will start doing by next October, when this mandate kicks in (assuming it won’t be postponed yet again). Yes, some operators will bite the bullet and cover workers whose hours extend beyond the 30-hour threshold. Others will opt to pay fines instead.

But in a field where labor is far and away the largest expense and where margins often hover in the single digits, it may be easier to simply hire more people, and have them work less time.

Industry lobbyists are now visiting lawmakers on Capitol Hill to explain their concerns with this mandate, and how it could have the unintended effect of harming resident care. These petitioners can expect to receive a warm reception and kind words, but little beyond lip service.

In fact, the real lobbying clout here is likely to come from a traditional hiring foe: the fast food industry. More than 20% of their employees work 30 to 36 hours each week. That’s more than twice the 8.9% rate seen across all industries, according to some estimates. Moreover, their profits tend to be even lower than long-term care’s, about 3% to 5% on average.

We seem to live in a world of unintended consequences. One we might soon see is this: thousands of frontline long-term care providers exchanging full-time jobs for multiple part-time jobs, thanks to a law intended to make their lives less difficult.

John O’Connor is Editorial Director at McKnight’s. Follow him on Twitter @ltcritr.