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Manchin Leads Bipartisan Effort to Better Address Nursing Home Staffing Shortages in Rural Communities

January 27, 2023

Washington, DC – U.S. Senator Joe Manchin (D-WV) led 13 bipartisan Senators in urging the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to avoid one-size-fits-all staffing mandates for nursing homes. Mandates, without provider flexibility in addressing recruitment and retention issues, would worsen existing staffing shortages in West Virginia and across the country, as well as place additional financial burdens on facilities in rural and underserved communities.


“We understand the importance of ensuring beneficiaries of federal health care programs have access to safe and high-quality nursing care. However, we fear a one-size-fits-all staffing mandate would undermine access to care for patients, particularly in rural communities,” the Senators said in part. “Instead, we urge you to work with Congress and rural stakeholders on tailored solutions that address the severe workforce challenges in our states’ underserved areas.”

 

The nursing home industry has been suffering from funding issues and severe understaffing, with 84% of nursing homes in the United States currently short on staff. CMS recently proposed a set of reforms to help improve the safety and quality of nursing homes, including a staffing mandate for nursing homes. While many of the reforms are necessary, minimum nurse staffing requirements could result in substantial financial pressure on rural and underserved providers, putting their ability to keep their doors open at risk.

 

The Senators continued, “Blanket staffing standards may not provide enough flexibility to nursing homes in light of well-known and long-standing obstacles to the recruitment and retention of direct care workers, especially in rural and underserved areas…Meeting staffing mandates will place nursing homes in financial jeopardy. This could lead to the shuttering of facilities, especially in rural communities. There is no question such a scenario would only amount to a counterproductive regulatory environment that leaves vulnerable patients and their families with far less access to care.”

 

Senator Manchin was joined by Senators Mike Rounds (R-SD), Jon Tester (D-MT), John Barrasso (R-WY), Steve Daines (R-MT), John Hickenlooper (D-CO), John Thune (R-SD), Gary Peters (D-MI), Kevin Cramer (R-ND), Deb Fischer (R-NE), Krysten Sinema (I-AZ), John Hoeven (R-ND) and Cynthia Lummis (R-WY).

 

The full letter is available below or here.

 

Dear Administrator Brooks-LaSure,

 

We write to express our concerns regarding the Centers for Medicare & Medicaid Services’ (CMS) intent to issue staffing mandates for nursing homes.

 

Like you, we understand the importance of ensuring beneficiaries of federal health care programs have access to safe and high-quality nursing care. However, we fear a one-size-fits-all staffing mandate would undermine access to care for patients, particularly in rural communities. Instead, we urge you to work with Congress and rural stakeholders on tailored solutions that address the severe workforce challenges in our states’ underserved areas.

 

While we support evidence-based policies to improve beneficiary care in nursing homes, staffing mandates are not the only solution. First, sweeping staffing mandates do not account for individual facilities’ operational capabilities and local workforce conditions. For example, minimum staffing standards that establish strict staff-to-patient ratios and/or minimum hours per resident day requirements may not reflect optimal staffing levels given differences in patients’ needs and underlying conditions, as well as the skills of the personnel at-hand.

 

Additionally, blanket staffing standards may not provide enough flexibility to nursing homes in light of well-known and long-standing obstacles to the recruitment and retention of direct care workers, especially in rural and underserved areas. This challenge is exacerbated by the fact that the health care sector is projected to have a shortage of nurses (10 to 20% based on a spring 2022 estimate) in the coming years.

 

Finally, meeting staffing mandates will place nursing homes in financial jeopardy. This could lead to the shuttering of facilities, especially in rural communities. There is no question such a scenario would only amount to a counterproductive regulatory environment that leaves vulnerable patients and their families with far less access to care.


Going forward, we recognize CMS as a crucial partner in identifying, mitigating, and preventing future health and safety problems in nursing homes. We stand ready to work with your agency on proposals to improve long-term care for patients.  The best way to accomplish this goal is working with Congress and stakeholders to ensure any future actions do not further exacerbate the serious challenges already facing facilities in rural America.



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