Lawmakers in Connecticut have conceded that the funding needed to increase mandatory, direct-care hours at nursing homes is not available as they contend with other priorities.
As a result, the staffing minimum is likely to remain at 3.0 hours per resident per day instead of increasing to 4.1, according to local media. The bill included ratios for specific nursing positions — something one of the sector’s leading advocates warned against.
“While our strongest objection is to the proposed breakout of specific ratios by nursing credential, we also must be realistic in recognizing that the current workforce shortage is thwarting the efforts of many aging service providers to staff at the higher levels to which they aspire,” LeadingAge Connecticut President and CEO Mag Morelli told committee members in February. “There are just too few people available to hire in nursing homes.”
The Connecticut Health Care Association opposed increasing staffing minimums “in the middle of the worst staffing shortages experienced in the sector,” even if additional appropriations had been made.
“The supply of workers for hire is simply insufficient in this environment,” President and CEO Matthew Barrett told McKnight’s Long-Term Care News late Tuesday. “Compliance with a higher standard would not be achievable due to the shortage of workers.”
Millions more in Medicaid money
The state’s Office of Fiscal Analysis found that lawmakers would need to increase Medicaid reimbursements by as much as $26.6 million in fiscal year 2025, $15.5 million in fiscal year 2026, and another $15.4 million the following year.
Beyond the funding problems, Morelli noted that “one staffing level does not fit all needs.”
“The needs and underlying condition of nursing home residents nationwide vary widely and to mandate specific ratios of CNA, RN and LPN within an overall minimum staffing level goes against the concept of flexing your staffing to meet the needs of the resident and flies in the face of our new acuity-based reimbursement system,” Morelli told lawmakers, adding that the ratios in the bill came from a decades-old study that failed to recognize residents’ “increased acuity.”
A report from the consumer group Long-Term Care Community Coalition based on data from the Centers for Medicare & Medicaid Services found that Connecticut ranks 24th in average direct care hours.
Morelli said that her association has urged CMS “to be realistic” on mandatory staffing minimums and suggested that state lawmakers hold off on their own regulation until the federal agency acts on its promised first-ever staffing mandate. Last month, CMS announced that skilled nursing facilities would see a 3.7% increase in the next fiscal year for Medicare Part A payments but it did not release any details on its staffing proposal.
“It is premature for the state to amend the current minimum staffing levels that were enacted into statute just two years ago,” Morelli said. “We need a long-term investment in aging services provider rates to assist providers with recruitment and retention of a strong and skilled workforce that is urgently needed as our state rapidly ages.”