Skip to main content

Round-Up: No Silver Lining for Staffing Mandates

Analysis  |  By Jasmyne Ray  
   September 13, 2023

The proposed federal mandate has been largely opposed, and state mandates haven't fared much better.

The proposed federal staffing mandate has been hanging like a dark cloud over the nursing home sector. Providers, who are already struggling to maintain staff amid a workforce crisis and financial strain, are largely against the mandate, many going so far as to advocate to their local and federal legislators against it.

The standards of the staffing mandate were released September 1, and are notably more strict than current states’ mandates. While there hasn't been a decision made yet, with the workforce crisis and funding struggles, there doesn't seem to be a silver lining for nursing homes.

Here are some previous HealthLeaders stories that detail how the sector has reached this point, the issues providers are struggling with, and how some states are currently managing their own staffing mandates.

Nursing Homes Doing the Best They Can Despite Financial, Hiring Struggles

Nursing homes saw a substantial portion of its workforce leave during the pandemic, and continue to struggle to recruit and retain workers. Additionally, the Medicare reimbursements that fund these facilities often don't cover the full cost of residents’ care, putting even more strain on their resources.

Nursing Homes Need $11.3B Annually to Meet Proposed Staffing Minimum

Facilities would need to hire over 191,000 nurses and nurse aides, estimated to cost $11.3 billion annually, to accommodate the minimum staffing mandate proposed by the Biden administration, according to a report by CliftonLarsonAllen LLP, an accounting and consulting firm.

At the time of the report's release, skilled nursing facilities were unable to accept new residents and concerned about potentially having to shut down due to the workforce crisis and increasing operating costs.

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

In July, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) sent a letter to the president with their suggestions on how improve the long-term care space. The suggestions included adding a customer satisfaction rating to the Five-Star rating system and Care Compare data, along with making efforts to supply, attract, and retain workers to long-term care by leveraging federal, state, and academic entities.

New York SNFs Stretched Thin Under State Staffing Mandate

Since the state implemented its own staffing mandate in January 2022, New York nursing homes continue to struggle to hire staff, particularly due to the state's low Medicaid reimbursement rates. Until 2023, facilities had seen only a 1% rate increase, forcing facilities to lower their occupancy to maintain operations.

LeadingAge Pennsylvania President on State of SNFs One Month Into Staffing Mandate

The state of Pennsylvania implemented its staffing mandate in July, with the state's nursing homes negotiating with legislators on the minimum staffing requirements in exchange for a $300 million increase in Medicaid funding.

Notably, many of Pennsylvania's nursing homes are having to turn away hospital transfers, causing an increase in the average length of a hospital stay, which is already costly.

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 

Get the latest on healthcare leadership in your inbox.