The federal staffing mandate handed down by the Centers for Medicare & Medicaid Services will cost the long-term care sector $6.5 billion each year, according to analyses from the American Health Care Association and a fellow sector observer.

A combination of those costs and the shortage of available long-term care workers also could place as many as 290,000 nursing home residents — nearly one-quarter of the total in the US — in danger of losing access to care, according to the analysis. 

Thursday’s report estimated that 94% of nursing homes will need to hire more staff to meet the mandate’s requirements — a total of more than 100,000 registered nurses and nurse aids. 

Analysis emphasized that the costs of the mandate would not be spread evenly across the country. Rural facilities and those that primarily serve Medicaid beneficiaries are less likely to meet the federal rule’s requirements, and thus more likely to incur the brunt of the costs of mandated hiring.

“What our new analysis confirms is what we’ve been saying for years: An unfunded, one-size-fits-all minimum staffing mandate for nursing homes would be impossible to meet and only threatens to limit access to care for our seniors,” said Mark Parkinson, AHCA’s president and CEO. 

The AHCA’s research department used federal data to reach its estimates, according to a report released alongside the analysis Thursday. 

A similar estimate was reached by Zimmet Healthcare Service Group’s analysis of the mandate, according to Marc Zimmet, the consulting company’s president and CEO.

“We came up with almost the same thing trending forward. If you add it all up, it’s just under 6.5 [billion],” Zimmet told McKnight’s Long-Term Care News Thursday.

Zimmet, however, noted that this $6.5 billion figure makes the assumption that facilities that have a surplus of one type of care worker (such as nurse aides) won’t let some of those workers go to help fund the mandated hiring of other workers (registered nurses, for example). Such a tactic might ease direct costs, though at the price of more “turmoil and turnover,” Zimmet explained.

Source: AHCA Staffing Mandate Analysis

High demand, low supply

Providers have consistently pointed out in recent months that the new staffing rules coincide with an ongoing workforce shortage in long-term care. 

“Nursing homes have been doing everything they can to recruit and retain more caregivers, but the available labor force is not there,” Parkinson explained.

Many providers have attempted to raise workers’ wages to increase the desirability of nursing home jobs, but with mixed results. 

In New Hampshire, for example, sector wages have risen more than 25% overall since the start of the COVID-19 pandemic in 2020, according to the New Hampshire Health Care Association. The total workforce, however, has not even recovered to pre-pandemic levels.

“Nursing homes can’t afford what the state pays staffing agencies,” Brendan Williams, president and CEO of NHHCA, said Thursday.  “This one-size-fits-all mandate would have you believe there are unemployed registered nurses sitting around … just waiting for a mandate to give them a job opportunity. The magical thinking behind it is ludicrous.”

Navigating a vicious circle

The combination of a shrinking supply of workers and an increased demand on nursing homes to provide hours of care per resident may force nursing homes to shrink the number of residents they serve — or even close entirely — the AHCA analysis predicts.

As many as 290,000 residents could lose access to nursing home care in the coming years, as their facilities adapt to the new federal requirements.

These combined pressures are likely to be even more pronounced for rural nursing facilities that frequently struggle to find adequate staffing and funding.

It’s critical to remember the unique circumstances that long-term care providers face, noted Zimmet.

“I have repeatedly expressed our firm’s position on the plausibility of this well-intentioned but poorly targeted initiative,” Zimmet wrote in a financial impact analysis of the staffing rule. “SNF residents deserve dignity, respect, compassion, and high-quality care from providers. The problem with applying a one-size-fits-none staffing mandate is the definition of care.” 

Nursing homes exist in very different areas of the country and do not exist in a traditional free-market setting due to their reliance on government reimbursements — some of which may not be using up-to-date and accurate data — he explained. 

Going forward, it will be vital for state and federal governments to consider not just adding funding for nursing homes, but how to distribute it so that the facilities which need it most can access what they need, Zimmet told McKnight’s