As debate continues to rage around the proposed federal nursing home staffing mandate, the rollouts of two state-level mandates illuminate the difficulties in enforcing these sweeping rules.
Rhode Island passed such a staffing mandate in 2022, but the state’s nursing homes have encountered so many difficulties even maintaining the status quo that Gov. Dan McKee (D) signed an executive order suspending all fines for noncompliance.
McKee raised concerns about new fines putting further stress on an already struggling sector. Last Friday’s executive order noted that Rhode Island nursing homes have actually lost 20% of their workforce since 2020, and six facilities have been forced to close in the same timeframe.
“The estimated net costs of enforcing the minimum staffing level … would be approximately $60 million, further straining nursing home resources and potentially resulting in additional closures, and forcing the relocation of residents,” McKee stated in the order.
New York is facing similar enforcement challenges after it also passed a staffing mandate in 2022, which went into effect in April.
That state notified nursing homes that were in noncompliance with the rule in August of 2023, according to CNY Central. Continued noncompliance could result in $2,000 per day fines for those facilities.
But the fines are still in limbo at the New York Department of Health for at least the next several weeks, and the department admitted that a severe shortage of healthcare workers is widespread across the state. This could allow nursing homes to formally appeal the penalties.
Long-term care leaders have praised both states for acknowledging the pressing workforce shortages faced by skilled nursing facilities across the nation. A willingness from state lawmakers to slow the pressure of staffing mandates could signal that those concerns are being taken seriously.
Meanwhile, consumer and labor advocates continue to press for increased staffing requirements, especially at for-profit nursing homes, saying that the mandates are vital for improving care quality and protecting residents’ health.
“Instead of giving nursing home owners free rein, it is critical that all stakeholders work together to hold nursing homes accountable to providing safe, dignified care,” said Jesse Martin, executive vice president of SEIU 1199 New England to the Providence Journal.
A majority of New York facilities are struggling to meet the mandate’s 3.5 hours of care per resident per day benchmark, and 11 have closed since 2020. Rhode Island’s mandate sets a similar standard of 3.58 hours per resident per day.
While both state marks are notably higher than the 3.0 hour mandate that was proposed by the Centers for Medicare & Medicaid services in 2023, a quarter or less of US nursing homes would currently meet the pending national requirements. With state leaders softening enforcement of their recent rules, questions arise about whether future policing of the CMS rule would lead to positive results or further sector strain.
