Skilled nursing facilities have relied on the staffing flexibilities allowed by the PHE, but what happens after they expire?
President Biden's announcement this week that the public health emergency (PHE) declaration for COVID-19 will end on May 11, may give skilled nursing facilities (SNF) cause for concern that their staffing needs won't be met before the PHE expiration.
The PHE had been renewed last month and was set to end in April, so the May date gives SNFs a little more time.
However, Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services, said in a statement, "While we appreciate the administration giving our mission-driven, nonprofit providers some time to plan, our members are severely outstretched and now face a new landscape of funding and rules while simply trying to survive."
Sloan added that outside of staffing waivers and flexibilities afforded by the PHE, there are also questions about policies and how the Biden administration will navigate a "true post-COVID country."
The pandemic caused many challenges to the healthcare sector, with SNFs being impacted the most. After intense media scrutiny at the height of the pandemic, the sector-wide labor shortage has nursing homes across the country struggling to maintain recruit and maintain staff.
A spokesperson for the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) spoke to HealthLeaders about the PHE ending.
"The resources the Public Health Emergency provided were crucial, especially as the pandemic exacerbated the labor shortage and economic crisis," they said. "Providers are now dealing with skyrocketing labor costs to attract workers and soaring inflation."
According to the spokesperson, Medicaid underfunding has always made it difficult for nursing homes to invest in their staff and services and maintain efficient operations. In its May 2021 reform agenda, AHCA/NCAL outlined funding strategies to help improve the sector. One suggestion was that reimbursement rates be updated regularly to keep up with inflation.
While the temporary nurse aid (TNA) waiver program provided some relief to nursing homes, allowing TNAs to work beyond four months with competency checks and training versus certification, the waiver expired in October 2022.
The Building America's Health Care Workforce Act, first introduced to Congress in May 2022 and reintroduced just last month, would extend PHE flexibilities by allowing TNAs to have on-the-job training count toward their certification to help bolster the workforce in nursing homes. In addition to preventing further job losses, the bill would protect seniors' access to care when the PHE ends.
"Hundreds of thousands of temporary nurse aides stepped up to serve vulnerable seniors during this global crisis, supporting residents with nonclinical tasks and offering companionship," the AHCA/NCAL spokesperson said.
"With many states unable to meet current training and testing demands, [the Building America's Health Care Workforce Act] will help temporary aides transition to permanent caregivers while continuing to serve their residents, supporting seniors' continuity of care."
“The resources the Public Health Emergency provided were crucial, especially as the pandemic exacerbated the labor shortage and economic crisis. Providers are now dealing with skyrocketing labor costs to attract workers and soaring inflation.”
spokesperson for the American Health Care Association and National Center for Assisted Living
The PHE declaration had recently been renewed last month and set to end in April.
Skilled nursing facilities have been dependent on the flexibilities they've been allowed as part of the PHE, especially in regards to staffing.
Legislation like the Building America's Health Care Workforce Act would help SNFs address their workforce struggles and ensure residents continue to recieve the care they need.