headshot - AHCA/NCAL President and CEO Mark Parkinson

A federal nursing home staffing mandate would be “impossible to implement” and a “disaster,” especially for seniors on Medicaid, the American Health Care Association/National Center for Assisted Living warned in a letter sent to President Biden Tuesday.

President and CEO Mark Parkinson reiterated the association’s serious concerns regarding an expected federal staffing mandate, once again highlighting historic labor shortages and unabating financial pressures in a system primarily  supported by government payers.

“If your administration imposes this mandate, more nursing homes will close, especially facilities that uniquely serve our most vulnerable,” Parkinson wrote. “Nursing homes that primarily care for residents on Medicaid won’t have the resources to recruit staff or pay for this mandate. Those facilities, as well as those who they serve and employ, will be hurt the most. To reiterate, this policy will have the opposite impact than intended. The unintended consequences will be numerous and damaging to the nation’s ability to serve seniors in need.”

The White House Office of Management and Budget continues to review a rule drafted by the Centers for Medicare & Medicaid Services. It was expected to be released this spring, but has been under review since May 30. OMB previously met with leaders from AHCA and LeadingAge. Such advisory meetings continued this week, with input being provided by the National Rural Health Association on Monday and the American Hospital Association on Tuesday.

As he sought to turn up the heat on decision-makers with Tuesday’s letter, AHCA’s Parkinson referenced more than 500 pandemic-era closures, highlighting that more than 40% of those were among four- and five-star rated facilities. He said the nursing shortage would make a new staffing mandate “impossible to implement,” requiring the hiring of 191,000 additional caregivers, including more than 44,000 RNs.

“It is hard for facilities to find one nurse,” he wrote. “The assumption that there are tens of thousands available to hire is preposterous.”

Parkinson also cautioned against viewing home- and community-based services as a turn-key alternative to nursing home care.

“The decreasing availability of nursing home care cannot be replaced by home and community-based services (HCBS),” he wrote. “Not only do nursing home residents require around-the-clock clinical care, but HCBS programs are not equipped to care for this influx of displaced seniors. The home care workforce faces similar labor challenges and has not kept pace with the increasing demand for HCBS.”

Parkinson again called on the White House to more seriously consider a series of “21st century” solutions, including immigration reform that would allow foreign-born aides and nurses to help nursing homes fill the 190,000 jobs still open after pandemic losses and add new roles.

“Nursing home residents deserve excellent, customized care, and we need to support and grow our workforce,” Parkinson wrote. “Given the acute nature of the long term care workforce crisis, we need a concerted effort for our profession. We hope to work hand in glove with your Administration on these targeted approaches to rebuild and strengthen the long term careforce. It’s not too late to reconsider this staffing mandate proposal and refocus on more meaningful solutions.

“It’s time to work together on real solutions. We all want better care in nursing homes. Let’s not make things worse in our efforts to improve.”