The Biden administration should stop its “incendiary descriptions” of the long-term care sector and focus instead on collaborative policy solutions, scolded LeadingAge president and CEO Katie Smith Sloan in an open letter to the president.
Sloan specifically highlighted two policy areas — building care worker immigration pipelines and increasing training pathways into the sector.
Meanwhile, a leading consultant called the sector outlook “grim,” given the “impossible” requirements of the staffing mandate.
Sloan emphasized that, while bad actors in the sector should be held accountable for poor outcomes, most in the sector are dedicated to delivering excellent senior care. The best way to improve outcomes is to form a collaborative relationship, rather than a combative one, the nonprofit leader added.
“I urge you to change your approach,” she wrote in her letter Thursday. “Rather than disparage us, partner with us. Visit our communities, meet the staff and leaders who work hard every day to ensure the health and well-being of their residents. Witness, first-hand, the innovations they’ve developed to navigate their workforce challenges. Hear what needs to be done to solve them.”
Spotlight on immigration
Sloan focused on the urgent need for expanding the long-term care workforce, which became all the more urgent after the Centers for Medicare & Medicaid Services issued its final rule April 22 to create a first-ever federal staffing mandate.
“This is no time to mislead the public and discourage potential employees from joining our ranks,” Sloan wrote. “Without the nurse aides, registered nurses, licensed practical nurses and other professional caregivers who serve nursing home residents, there is no care.”
Sloan’s letter specifically highlighted immigration reform as a pathway the administration could take to address providers’ staffing needs.
Opening that pathway has become critical since the finalization of the mandate, said Melissa Brown, COO at Gravity Healthcare Consulting.
“There has never been a more critical point for SNF staffing needs to be addressed in a practical, pragmatic and effective manner,” Brown told McKnight’s Long-Term Care News Friday. “If you look at the numbers of available nurses, it is literally impossible to meet this staffing mandate with the current workforce.”
Immigrant care workers have been one of few bright spots in the long-term care workforce in recent years — holding steady where many other care workers have left for other industries.
“I don’t see any way forward without immigration staffing solutions in place. The numbers simply don’t work,” Brown said. “Ultimately, unless the Biden administration collaborates with the people actually providing this care and overseeing the actual operations of SNFs, the future is grim.
“The absolute result of this staffing mandate will be reduced access to care for seniors, especially in rural locations, and will also disproportionately affect people at a lower socioeconomic level.”
Other experts focused on more domestic workers as a solution to the staffing crisis, especially in rural areas.
“I don’t see immigrant workers being the sole solution for rural providers staffing needs,” Maureen McCarthy, president and CEO of Celtic Consulting told McKnight’s Friday. “Generally immigrants coming into the United States gravitate towards urban areas with more social supports.I think that adding programs to the high school and potentially even middle school curriculum, may be more effective in developing healthcare workers.”
McCarthy also suggested implementing “career ladders” to help workers further their education and advance to greater responsibilities and compensation within the sector.
Stronger together
Brown noted that even if the workforce policies Sloan advocates for are put into place, it still might not be enough to offset the costs of the CMS mandate.
Sloan also focused on the price of the mandate — not just to providers in the short term, but potentially to seniors in general.
“Our members will struggle mightily to comply,” she said. “It is a simple issue of supply and expenses. These new minimum staffing requirements, which come with no additional funds for recruitment, training or support for increases in Medicaid reimbursement (the main source of nursing homes’ funding), will likely result in unintended consequences. Older adults’ and families’ existing difficulties in accessing care will worsen.”
The potential costs in terms of access to senior care should motivate providers and policymakers to work together on funding and workforce solutions, Sloan stated.
Providers at the state level have at times achieved significant policy goals by forming active and collaborative relationships with policymakers. Florida nursing homes, for example, recently won the largest increase in Medicaid funding on record thanks in part to its three-pronged advocacy approach.
