Two weeks after a judge broke federal staffing standards for all U.S. nursing homes, questions about the future of the rules continue to swirl within the industry.
Will the government appeal a district court ruling in Texas and continue to fight for restrictions that will force nursing homes to create more than 100,000 new jobs in the coming years?
How would a judge who heard a similar challenge in Iowa interpret a similar argument? And what happens if the rulings are inconsistent with each other?
Can Congress intervene through a solution that puts the entire rule to bed much faster than any lawsuit?
Whether rules go away or not, there is one clear expectation for industry insiders. The legacy continues to rub nursing home leaders, recruit quality staff and face strong pressure to improve patient care.
“The literature makes it clear that quality of life and quality of care are related to staffing, and that doesn't just mean the number of staff. It means both staff validity and staff skills.” “We need to use this argument that we've brought for the past two years. We need to use it as a call to action. We have to take action now.”
Given the growing awareness of staff shortages, reduced labor pools and aging, Bonner said it would be “merciless” to keep policymakers and healthcare providers from gathering on actual solutions.
It is also hard to imagine that consumer groups and unions that supported mandate will abandon the pursuit of additional nursing home requirements, which have been repeatedly portrayed as residents who have failed during Covid.
The provider publicly opposed the nature of staffing mandate ordinances in regards to coverage and daily minimum ranges for registered nurses 24 hours a day. But they almost universally agree that the sector needs more staff. Many argue that there are significant wage increases and additional benefits that are not doing their jobs, and instead of regulations, governments are needed to create more attractive workforce incentives.
“We're looking forward to seeing you in the process of exploring our customers,” said Steverafort, vice president of corporate affairs at Idaho-based Cascadia Healthcare. “That's something we need to focus on. All the parties involved. Whether it's CMS, HHS, parliamentary, government, national health and welfare agencies, unions, operators, we won't come up with a solution unless all parties are involved.”
A encounter in the heart?
Consumer advocacy groups were relatively quiet after the Texas ruling.
However, they are still very supportive of the rules and what it supports, claiming that approximately 3.48 hours of daily nursing care required is not fully undertaken by the promised Centers for Medicare & Medicaid Services.
The Center for Medicare's Advocacy was one of seven consumer organizations that submitted short support in favor of government grounds for rules in the Iowa case. The judge has reconsidered whether to grant an injunction and is effectively blocking enforcement for now.
The CMA argues that the rules save residents' lives and ensure the health, safety and rights of residents, and that regulators have the right to enact and enforce mandates. This is an important consideration for providers who may face future efforts to impose alternative regulations.
“When you read the court's discussion on the issue of skilled nursing space, the judges are aware of the fact that skilled nursing has staffing issues and there are bad players,” said Attorney Greglimonselli, co-chair of the Senior Living and Care Team at Akerman LLP.
He predicts further attempts to regulate staffing, particularly at the state level.
“If state regulators don't blindfold or disrespect what operators are saying, the way I see it. If people just talk about how we can get the best care for our residents, then that kind of rule is really not important,” he told McKnight's. “It's certainly true that there should be a minimum, but I think states can probably choose the minimum better than the federal government can.”
The 2022 Federal Commission reported that 38 states had some form of minimum staffing requirements for nursing homes, while nine states required less than two hours a day of direct patient care.
Welcome changes
With staffing rules in some states achieving more challenging operating conditions, providers have continued to focus on other laws or regulations that can support voluntary efforts to improve staffing. Leadingage and the American Health Care Association advocate specifically for flexibility and immigration reform training.
Just as Republicans are trying to cut federal spending significantly, funds are important, and providers want it to increase. Advocating for better Medicaid funding could bring in place providers, consumer advocates and unions, but in the past, many nursing home critics have accused providers of siphoning revenue.
Health Dimension Group CEO Erin Hennessy said McKnight's rules defeat would closure, bankruptcy and hinder recipients.
“There are (providers) who can't actually survive, especially in the rural and Medicaid communities,” she said. “We have to accept the story to the end. The end of the story is access.”
Active providers
“We don't want five-star staffing, so we're not pleading with rules. We all want to have five-star staffing. We're fighting for it because we believe in rural health access and low-income Medicaid earners,” added Hennessy. “Our patients come with higher vision and need workers. So, regardless of staffing duties, this must be the number one mind for the operator.”
Health dimensions have revamped the entire staffing approach, adopted in the hands of concentrated teams, taking responsibility from building leaders, ensuring more new recruits. When employers needed constant communication, it was a way to help solid candidates not slip through the cracks, Hennessy said.
Nate Schema, a good Samaritan president and CEO, said a legal victory in Texas
“Perform the path to a more thoughtful approach,” shifts focus from strict assignments to individual needs of residents.
As the country's largest rural provider, his organization is looking for meaningful policy solutions to support international recruitment and efforts to enable more virtual care by licensed nurses.
Bonner points out that the Mandate fight has helped bring nurse aide jobs to public, and the CNA remains the “backbone” of the sector. She has three wish lists that will help her attract more, from high quality work to her.
This helps state or federal staff to train certified nurse aides free of charge. Provide loan forgiveness. And allow nursing homes to provide training and promotion opportunities for low or free.
“I don't think it's all in nursing homes,” she said. “Maybe it's a regulatory process. Maybe we do it without regulations. This is always a good thing.”
Laforte loves the ideas of more private partnerships, such as Dwyer Workforce Development built with providers, training and embedding frontline nursing staff and providing wrap-around services that keep them on track.
“I hope that's the future and hopefully there will be more initiatives like that,” he said. “As a sector, we can pick up that ball with our public partners and come up with workforce solutions. That's the only way to ensure the long-term sustainability of care quality care as demographics change.”
