Seema Verma, former CMS head, spoke out yesterday regarding the proposed staffing mandate (hours and type of staff, per resident per day) proposed rule, indicating her opinion that the approach was flawed. A recap article on her comments is here: https://www.mcknights.com/news/former-cms-chief-verma-regulators-over-their-skis-with-staffing-mandate/?utm_source=newsletter&utm_medium=email&utm_campaign=NWLTR_MLT_DAILYUPDATE_110223&hmEmail=IjP1GPaY%2BJ2uvsLxTJ79bVeRWY7ycbnr&sha256email=aa4cb7c695037c31a216b9562788596b6fcd012145d566f31440b6fcd139c8a9
Regular readers know that I have covered various topics on healthcare staffing, particularly as the same relates to senior living, post-acute care, etc. I did a piece on the proposed staffing mandate rule when it was released, this summer. That article is here: https://rhislop3.com/2023/09/01/cms-releases-rule-on-snf-staffing-mandate/
The challenges with the staffing mandate are multiple but, in the end, the real crux can be boiled down to two significant issues. First, there simply is not enough staff, especially licensed nurses, to fill the requirement. Supply does not match the demand that exists now and certainly won’t, if and when, the mandate goes into effect. Second, the cost of the mandate is not sufficiently funded by Medicare or Medicaid current reimbursement levels. Provider resources in terms of dollars for additional staff, as proposed, aren’t today available, especially considering other inflation impacted costs (energy, food, capital). In some markets, rural and exurban in particular, there are real challenges to not only attract staff, but to retain them. Given the current competition for bodies across health care, staffing costs have risen far faster than reimbursement.
Back in June of 2022, I did a podcast on building staffing levels back to safe levels post-COVID. In the presentation, I addressed a number of the labor challenges providers face. The transcript of that podcast is available here: https://www.healthleadersmedia.com/post-acute/bringing-long-term-care-staffing-back-safe-levels
While politically palatable, staffing mandates of any type in health care today, are impractical. The desire to have facilities and programs fully staffed is certainly appropriate however, the issue is a supply challenge, and no rule will create additional nurses, CNAs, etc. What is a better strategy is for the government to prioritize policies that have a chance to increase the nursing labor pool and to address the frustrations nurses in health care face (overregulation is good place to start).