A direct staffing requirement Pennsylvania leaders teased as a ‘historic’ nursing home announcement drew fast and sharp criticism from providers Wednesday.
Acting Secretary of Health Alison Beam called the administration’s proposed regulation a “bold step forward,” noting the state has not updated regulations governing its 692 licensed nursing homes in nearly 25 years.
But the call to increase minimum direct staffing hours from 2.7 hours per resident, per day to 4.1 was roundly rejected as unrealistic by those representing providers.
“In our current operating environment, this proposed regulation is an unattainable, unfunded mandate that will cripple an essential component of the long-term care continuum in one of the oldest states, in terms of population, in the entire country,” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association. “This announcement is not ‘historic.’ Instead, it’s history repeating itself.”
The state, Beam said, began reviewing its nursing home regulations in 2017 with a broad stakeholder group. But Shamberg noted that the workgroup was disbanded in 2018 before industry representatives could give meaningful input.
Adam Marles, president and CEO of LeadingAge PA, called the proposal “disappointing, but hardly surprising” given the state’s record on Medicaid funding.
“Our members support best staffing practices and provide high-quality senior care, but a lack of state funding continues to stretch our resources to the very limit,” added Marles, noting that Medicaid funding has been stagnant under Gov. Tom Wolf’s (D) administration. “This latest unfunded mandate for staffing couldn’t come at a worse time as long-term care facilities are still fighting a pandemic while suffering the worst staffing crisis in generations.”
That crisis could come to a head at 21 facilities next week, as more than 1,500 nursing home employees are set to conduct a one-day walkoff to bring attention to staffing shortages.
The Pennsylvania Health Care Association estimates increasing staffing levels to the proposed minimum would require an additional 7,000 direct care workers and cost operators $6 million per week in new wages, a statewide total of more than $300 million per year. The regulations sent to the General Assembly Wednesday do not include a funding mechanism.
“Providing 4.1 hours of direct care not only aligns with best practices and existing research but it prioritizes resident well-being,” Beam said at a press conference outside Homeland Center in Harrisburg, PA, one of 125 state facilities already hitting the 4.1 threshold. Another 134 facilities provide between 3.5 and 3.99 hours of direct care, and an additional 334 provide 3.01 to 3.49 hours, according to Beam.
National healthcare leaders called on CMS to establish a direct care minimum of 4.13 hours in the early 2000s, but the agency has never adopted a requirement.
Providers will have an opportunity to comment on the proposed regulations — and a set of four others to follow — during an approval process expected to stretch through 2022.
“We also look forward to discussing ways that we can partner with the industry to ensure ongoing viability of the nursing home industry in Pennsylvania, which may include increased reimbursement, critical workforce development programming and other funding opportunities,” Beam said.