With increasingly overheated rhetoric, the American Health Care Association (AHCA) explicitly asks President Biden to abandon his commitment to enacting meaningful nurse staffing ratios for nursing facilities. LeadingAge’s “Get Real on Ratios” would gut staffing ratios with qualifications, conditions, and exceptions.
American Health Care Association
AHCA President & CEO Mark Parkinson’s July 11, 2023 letter to the President is a tired rehash of old arguments, but offers no response to the most critical fact – nursing facilities are grossly understaffed and have been grossly understaffed for decades, resulting in avoidable suffering and death of nursing facility residents. Although staffing shortages did not begin with the pandemic, the pandemic vividly showed the public the consequences to residents of staffing shortages. Facilities cannot continue to have too few well-trained and well-compensated staff providing care to residents.
Parkinson admits that although “other health care sectors have largely recovered” from pandemic staffing shortages, nursing facilities have not. Why not? Because low salaries, lack of benefits, and poor working conditions have, understandably, made potential staff members seek employment elsewhere or leave their jobs quickly. Nursing facilities’ most critical staffing problem is often retention of workers, rather than the initial recruitment of workers.
AHCA describes nursing home closures, but nursing home closures are not a new phenomenon. Facilities have closed in large numbers for years, and often because they provide poor care and have low occupancy. Recently, deliberate state policies have called for replacing institutional care with more home and community-based services, which older people and their families overwhelmingly prefer.
Parkinson’s call for “21st Century solutions” repeats proposals for immigration reform, which would offer, at best, an almost inconsequential number of new staff; undefined “innovative technology;” and “continuing our efforts to help seniors stay at home as long as possible,” an irrelevant recommendation in this discussion.
LeadingAge’s Get Real on Ratios proposes six “common sense conditions that must be met before mandatory nursing home staffing ratios could be implemented.” These conditions include
- a determination that Medicaid rates cover at least 95% of the cost of care – a requirement for payment adequacy that the Medicaid and CHIP Payment and Access Commission (MACPAC) says is impossible to determine at present with the limited information available on states’ supplemental payments, how facilities currently spend their reimbursement, related party transactions, Medicaid post-eligibility rules, and other factors;
- certification by the Secretaries of Labor and Health and Human Services that “there is not a shortage of potential employees qualified to work in long-term care settings” – an undefined condition impossible to meet; and
- “flexible” standards – in other words, no minimum nurse staffing standards at all.
AHCA and LeadingAge need to stop opposing nurse staffing ratios, proposing impossible conditions, and scaring residents and staff about the wrong issues. The real issues that will enable facilities to retain staff are paying living wages and benefits, providing decent respectful working conditions, and employing sufficient numbers of staff. AHCA and LeadingAge and their member nursing facilities need to become part of the solution to increase staffing levels in nursing facilities. Residents, families, and staff deserve, and have a right to demand, no less.
July 20, 2023 – T. Edelman