Jan Schakowsky

Two members of Congress joined national union leaders Thursday in accusing nursing home owners of diverting federal funds away from patient care in what was ostensibly a rally in support of a federal staffing mandate.

In calling on the Centers for Medicare & Medicaid Services to hasten its adoption of a first-ever national staffing minimum to support beleaguered frontline workers already in place, Rep. Jan Schakowsky (D-IL) also painted nursing home owners and their top advocacy organization, the American Health Care Association, as “the opposition.”

She said AHCA had spent $3.9 million lobbying Congress on the staffing mandate issue last year. AHCA leaders say they have embraced the idea of increasing staff, but they also have cautioned that mandating hiring when the sector remains down more than 200,000 workers from its pre-COVID levels could lead to disaster for some facilities.

“We are not against hiring more staff — we would love to hire more caregivers, but in this current labor market and with limited resources, the workers simply do not exist,” AHCA said in a statement to McKnight’s Long-Term Care News on Thursday. “It will be impossible for nursing homes to meet an unfunded mandate without any supporting workforce development programs or funding. It’s our nation’s seniors who will feel the impact if this policy proceeds — with fewer options and longer waiting periods for care.”

Demographics play a major factor, especially with many nurses leaving the sector or retiring after three years of pandemic conditions. The US is expected to need an additional 13 million nurses by 2030, representing almost a 33% percent growth. AHCA and LeadingAge, which held its annual Washington, DC, conference this week, have been pressing federal lawmakers for better funding and immigration relief in the face of staffing demands that aren’t being met locally.

Union issues demands

In an hour-long event at the Cannon House Office Building on Capitol Hill Thursday, union members who work as CNAs in Oregon, Florida and Illinois shared stories of working in buildings where they have been left to tend 15 to 30 patients alone on some shifts. They were joined by Rep. Lloyd Doggett (D-TX) in saying warnings that nursing homes might have to close or limit access because they wouldn’t be able to meet new standards “propaganda.”

“We’re going to demand that our federal government not allow Medicare and Medicaid dollars to finance poverty-wage jobs,” SEIU1 President Mary Kay Henry said. “We are going to make these jobs good jobs. Just like auto jobs of the last century were bad jobs, they became good jobs through unions.”

Doggett and Schakowsky spearheaded a letter-writing campaign in March that urged CMS to go ahead and issue its staffing rule. Thursday,  Schakowsky laid out talking points backed by SEIU national, including a call for a per-patient, per-day staffing ratio and a $25 minimum wage for direct care workers.

“SEIU started the ‘Fight for $15,’ but that isn’t it anymore,” Schakoswky said to a crowd of nursing home CNAs and national union leaders. “You need a lot more than that.”

Lawmakers on the offensive

She noted the Biden administration’s continued focus on nursing home quality improvements. They started with his 2022 State of the Union address and stretched to this week’s issuance of an executive order again calling for a national staffing mandate.

“We have to make sure that isn’t just the minimum, but we’ll start there, and we’ll make sure the staffing ratios do what you need to protect, to save the lives, of people in nursing homes,” Schakowsky said. “We are saying it is time for a dramatic change …. [But] the American Health Care Association, which reps two-thirds of the nursing homes, are right now lobbying against you and lobbying against our efforts…. We know who the opposition is now.”

While AHCA could not confirm its lobbying spending in 2022 by deadline, a spokeswoman noted that a study put the annual cost of an expected mandate at a much higher $11 billion annually. AHCA said long-term care providers need financial support and not just more dictates from the federal government, which serves as both the overseer and biggest funder of the vast majority of nursing homes in the US.

“Here’s what we are for,” AHCA said in its statement. “[I]nvesting in our caregivers so nursing homes can offer more competitive, good-paying jobs; policies and programs that help attract more individuals to build a career in long term care; and staffing requirements that are customized to each resident’s care needs.”