Providers think resident satisfaction survey results should be incorporated into sector improvement efforts. (Source: ProfessionalStudioImages/Getty Images)

The nation’s largest nursing home association stung the administration with its own words Monday when it sent the White House another letter arguing against a planned federal nursing home staffing mandate.

Such a proposal would be in direct opposition to what the same regulators said seven years ago when they warned that a “one-size-fits-all” rule would not result in better care, the American Health Care Association wrote.

The provider group also offered four recommendations the federal government could implement instead of a national staffing rule that could result in drastic, “unintended consequences.” The recommendations are well-known to close observers as proposals AHCA has also made previously in its reform plans.

The association noted that the Centers for Medicaid & Medicare Services warned in 2016 that a “‘one-size-fits-all’ staffing minimum would not improve quality of care in nursing homes.” It is AHCA’s second letter to the White House in 13 days on this topic.

CMS officials wrote in a Federal Register entry on Oct. 4, 2016, the following about participation in federal programs for long-term care facilities: “We continue to be concerned that a mandated ratio could result in unintended consequences, such as staffing to the minimum, input substitution (hiring for one position by eliminating another), and task diversion (assigning non-standard tasks to a position), as well as stifling innovation, and would not result in the improved quality and person-centered care that we seek in facilities.

“[W]e do not agree that we should establish minimum staffing ratios at this time. As discussed in the preamble to the proposed rule, this is a complex issue and we do not agree that a ‘one size fits all’ approach is best.”

AHCA, fellow provider group LeadingAge and their state affiliates have been vociferous in their opposition to a staffing mandate the sector observers could require nursing homes to provide 4.1 hours of direct care per resident per day. The associations and other advocates point to the national staffing crisis that will make it near-impossible for facilities to be in compliance with such a rule. 

Instead, AHCA suggested in its letter that the federal government “refocus” on other ways to improve the quality of care in nursing homes, namely: 1) publicly reporting resident and patient satisfaction; 2) building up the workforce; 3) improving the Special Focus Facility Program; and 4) enhancing CMS’s Value-Based Purchasing Program. 

“We understand that the original intent of proposing additional federal staffing requirements is to enhance care — nursing home providers share in this noble cause,” association President and CEO Mark Parkinson wrote in the letter. “In reality, staffing mandates will only limit access to care for our nation’s seniors, as nursing homes will be forced to restrict the number of residents they can serve, or close altogether. 

“COVID-19 was an inflection point for our profession, and we believe in order to learn from this international tragedy, bold steps must be taken to improve the long-term care system. However, meaningful change will not happen through unrealistic requirements and enforcement, but through collaboration and innovation.”

CMS said earlier this year that it would release the staffing mandate in the spring of 2023, but as of Monday, the agency still had not released any details or language of a proposed rule.