Skip to main content

AHCA/NCAL Suggest Staffing Mandate Alternatives in Letter to President Biden

Analysis  |  By Jasmyne Ray  
   July 27, 2023

The Biden administration's proposed staffing mandate could cause more harm than good to struggling facilities.

Post-pandemic, the Biden administration has increased efforts to hold the nation's skilled nursing facilities (SNFs) accountable for the quality of care they provide. Such efforts have included potentially implementing a staffing mandate, which many facilities have been vocal in objecting.

Earlier this week, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL)sent a letter to President Biden outlining alternative solutions to be implemented instead of a staffing mandate.

In the letter, Mark Parkinson, president and CEO of AHCA/NCAL, acknowledged the impact the pandemic had on the healthcare sector and its workforce, as well as the need for improvements in the long-term care space.

"However," he added, "meaningful change will not happen through unrealistic requirements and enforcement, but through collaboration and innovation."

In the letter, available on the organization's website, AHCA/NCAL offer four policy proposals to help address the quality of care in nursing homes:

  1. Publicly report customer satisfaction: Add a customer satisfaction measure to the Five-Star rating system and Care Compare data from the Centers for Medicare and Medicaid Services.
  2. Build the long-term care workforce: Implement the efforts outlined in the Care for Our Seniors Act workforce proposal to supply, attract, and retain workers in long-term care by leveraging federal, state, and academic entities.
  3. Improve the special focus facility program: Begin incorporating evidence-based performance improvement approaches designed to help the facility improve quality care of residents they serve and successfully graduate from the program.
  4. Enhance CMS SNF value-based purchasing program: Add a measure about adopting systems of care related to high performance, as defined by the U.S. Department of Commerce Malcolm Baldridge Framework, which would drive systemic quality improvement.

"We understand that the original intent of proposing additional federal staffing requirements is to enhance care," Parkinson wrote. "However, given the current and forthcoming caregiver shortage, we do not believe a federal staffing mandate will be feasible nor will it yield the intended outcome of improving care."

“Meaningful change will not happen through unrealistic requirements and enforcement, but through collaboration and innovation.”

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 


The Biden administration has proposed a staffing mandate to address the issues with quality of care in the nursing homes, which many facilities are against.

In a letter to President Biden, the AHCA/NCAL proposed alternative solutions such as allowing patients to report their satisfaction via CMS data and working with academic institutions to develop a pipeline of talent.

Get the latest on healthcare leadership in your inbox.