A major provider organization Thursday called out a newspaper’s national investigation into nursing home staffing as “unfair and mischaracterized.”

USA Today’s lengthy article focused on staffing benchmarks set by federal agencies, understaffing of facilities and the harm it causes residents and staff, and the low percentage of citations compared to the number of understaffed facilities the paper found in its investigation. 

The American Health Care Association told McKnight’s Long-Term Care News in an email that USA Today’s use of the 4.1 HPRD recommendation from 2001 and CMS STRIVE calculations to analyze today’s nursing home staffing levels is unfair since nursing homes are not required to meet these standards. 

“We are extremely disappointed in USA Today’s unfair and mischaracterized reporting,” AHCA leaders said. “The analysis that USA Today bases their claims on is flawed. The vast majority of nursing homes are committed to providing surveyors with accurate, complete information, and the current payroll-based journal reporting system is auditable and robust; 99% of nursing homes are currently meeting the federal government’s process to determine sufficient staffing.”

The sector expects the federal government to mandate staffing minimums sometime in the first half of 2023; the Centers for Medicare & Medicaid Services has been trying to determine what that standard should be. Right now, according to CMS, federal law requires Medicaid- and Medicare-certified facilities to offer 24-hour licensed nursing services, “sufficient to meet nursing needs of residents.” 

Determining sufficient staff is up to each facility’s assessment of what its residents need per care plans, CMS said. There must be a registered nurse at least eight straight hours every day of the week.

The article continues a long trend of painting long-term care with a negative, broad-stroke brush, Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, told McKnight’s.

“USA Today leveraged data, submitted by providers to promote transparency, and used it to depict a negative narrative without exploring all of the nuances of regulatory parameters set by individual states,” he said.

“The federal staffing minimum threshold cited in this article is not a staffing requirement. It is merely a recommendation from a CMS report that was released more than 20 years ago. And 15 years after that report, CMS acknowledged that, while sufficient staffing is important, the federal agency didn’t agree with setting a nationwide minimum. More importantly, CMS went on to say it does ‘not agree that a one-size-fits-all approach is best.’”

Shamberg added that survey practices vary widely throughout the country, and even throughout the state of Pennsylvania. 

“This creates inconsistencies, and it’s not fair to providers, workers, residents, or their families,” Shamberg said. “Ultimately, it is the responsibility of regulatory bodies to address areas of concern, and if care is being jeopardized, action should be taken — but determining that action should be standardized, not discretionary.”

AHCA and other advocates don’t argue with staffing shortage facts, only that mandatory minimums and punishment are not helpful for a problem that needs recruiting and retention solutions. 

“What the media and policymakers should be concerned about is how the workforce shortage in long-term care is creating an access to healthcare crisis that affects all providers,” AHCA told McKnight’s Long-Term Care News. 

“CMS officials have stated previously, and we agree, that staffing minimums are not an effective staffing approach. A new, federal staffing mandate without the available workforce and financial resources necessary to meet it would reinforce a punitive process that hasn’t been working for decades, fails to address the root cause of our sector’s staffing challenges, and would take precious resources away from investments in staff and advancing care for residents.”

The article noted that 35 states have their own staffing requirements. Florida is one of them, requiring 3.6 total combined direct care hours per resident per day. That includes 1 hour of licensed nursing care and a minimum of 2 hours of CNA direct care. As a result of legislation passed during the 2022 session, the remaining .6 hours can be met by additional specialists, such as therapists, mental health social service workers or activity professionals who are helping to meet residents’ care needs, according to Florida health Care Association spokesperson Kristen Knapp.

On average, Florida’s nursing centers staff above the minimum requirements at 4.0 total direct care hours per patient per day, ranking it in the top 15 percentile in the nation, Knapp said.