Unfortunately, the Biden Administration and the Centers of Medicare and Medicaid Services (CMS) proposed a rule in early September that they indicate will solve a “quality issue” in nursing facilities, but is blind to the fact that there is a shortage of caregivers. Their proposal is a one-size fits all staffing mandate for nursing facilities. This will create more regulations to punish all nursing homes, and does not take into consideration that a majority of these facilities are doing the right thing and the best they can.
This proposal is dangerous and won’t work. Not only is every city, county, and state different; this rule does nothing to address the root problem or help rebuild the workforce needed. In fact, it does the opposite. More regulations will drive great caregivers from working in nursing facilities. This is something we as a nation cannot afford. Approximately 15 %, 250,000, healthcare workers left long term care between 2020-2022 due to the COVID-19 pandemic. Today, only 100,000 have returned. To offset this staffing challenge, most nursing facilities have shut down hallways/units and limit the number of patients from the community or hospitals, reducing access. Unfortunately, 600 nursing facilities nationwide have closed since 2020- 30 of them in Ohio. (The only state with more closures over this timeframe is Texas).
This trend cannot continue. The 81 nursing facilities in the greater Dayton area and the caregivers serving in them are an essential part of our health care system. While it would be great if everyone could be taken care of at home, the reality is, the care needs are too great for the majority in long-term care facilities. Although fewer individuals in the aging population will need nursing facilities than prior generations, the sheer number of Baby Boomers will increase the need for nursing facilities over the next 20 years. This is coinciding with an aging RN workforce. Without action, the workforce shortage in healthcare will continue. In the next five years, over 500,000 registered nurses are expected to retire, and The Bureau of Labor and Statics projects we will have 200,000 openings for RNs per year until 2031. We need to prioritize building our workforce.
Beyond overlooking staff shortages, this rule doesn’t increase funding, and nursing facilities are underfunded. Pricing is NOT set by the facility. Over 90% of nursing facilities’ funding is set by the state and federal Medicaid and Medicare respectively and Medicare Advantage Plans. Most states’ Medicaid systems underfund facilities by only paying 70-80% of the actual cost of care. Without proper funding, nursing facilities struggle to offer care workers competitive wages, especially in the face of national workforce shortages. While the Ohio Legislature and Governor Dewine increased funding to Ohio nursing facilities in the most recent budget with 60% of the additional funding based on quality outcomes; it’s just the first step to begin to rebuild the workforce in Ohio’s facilities.
Our priority right now must be substantive solutions to help develop the next generation of caregivers. We need a unified national plan to rebuild nursing facilities and our nation’s healthcare workforce – one that is collaborative and forward-thinking. We should prioritize building our workforce by reaching young people early. Increase high school-based nurse aide training programs and licensed practical nurse (LPN)/licensed vocational nurse (LVN) programs across the county to encourage more nurses to enter the workforce. Immigration reform is also critical to addressing our workforce shortages. We need to create a common-sense visa system that allows the government to ensure workers and employers are utilizing the system as it was intended, and cuts out unnecessary obstacles. Nursing facilities also need financial support and initiatives to develop future caregivers which in turn will continue to enhance quality. More penalties and regulations are not, and have never been, the answer. We need Federal support and ask Senators Brown and Vance to take a lead on this issue so we can continue to provide high-quality care and support for the growing number of residents we serve.
Chris Chirumbolo is the CEO of Carespring Health Management.
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