headshot - AHCA/NCAL President and CEO Mark Parkinson
American Health Care Association / National Center for Assisted Living President and CEO Mark Parkinson

Skilled nursing facilities would have to shell out $12 billion in order to comply with two staffing proposals in President Joe Biden’s social spending plan, according to the American Health Care Association. 

The Build Back Better Act is scheduled to be passed by House lawmakers this week and undergo an analysis by the Congressional Budget Office before heading to the Senate for negotiations. Provisions that dictate staffing ratios and triple the registered nursing minimum coverage have providers particularly worried.

The first calls for the Health and Human Services secretary to conduct a study to determine the ideal minimum nurse staff-to-resident ratio for SNFs and then mandate that minimum requirement for facilities. The second provision would require SNFs to have an RN  present 24 hours per day, which would be an increase from the current federal requirement of eight hours. 

The proposals not only ignore the industry’s need for more help but “makes the situation much worse,” said Mark Parkinson, AHCA president and CEO, who also acknowledged their good intentions and aim to improve quality of care. 

“Unfortunately, if these provisions actually became law, we believe that thousands — if not most — of the skilled nursing facilities would close,” Parkinson said. “I know that’s a dramatic statement, but we believe it’s true.” 

AHCA estimates that the industry would need to hire an additional 171,000 workers to comply with both measures; this would come after the industry lost 221,000 jobs between March 2020 and October 2021. The additional staff would cost providers $12 billion total, Parkinson said. 

“While these two provisions sound great — again, we believe they’re well-intentioned by people who want to improve care,” he added. “They’re just not realistic in the real world.” 

Parkinson said that this situation demonstrates what happens “when bills are passed without regular order, without hearings, without discussion, without deliberation, without collaboration. You end up with things that sound good but in fact have unintended consequences.” 

Phil Fogg Jr., AHCA Board Chair and Marquis Companies president and CEO, said the unfunded provisions are “frustrating” to providers.

“It’s especially challenging to us with the environment that we’re dealing with right now to say, ‘Not only are we going to require it, but we’re not going to fund it,’” he said. 

“This would be the most inopportune time to feel that we are somehow legislatively doing something good on behalf of the elderly residents we serve by mandating staffing when we can’t deliver it,” added Leonard Russ, principal partner and administrator of Bayberry Care Center in New Rochelle, NY, and a past AHCA Board Chairman.