WORKFORCE
From the outset of the Biden Administration, it’s been clear supporting nursing home care is not a federal priority. That was accentuated in the inflation-driving American Rescue Plan Act, which funded pretty much everything else under the sun. According to an administration “Fact Sheet,” it dedicated $37 billion in new investment in home and community-based settings (HCBS). Unmentioned, however, is it spent nothing to help nursing home caregivers.
Instead of supporting nursing home care, the administration has cherry-picked data to denigrate it. It has, for example, obsessed over nursing homes owned by private equity firms, even though the U.S. Government Accountability Office estimates only 5% are. Other health care investments are far more attractive to private equity — whether it’s “gobbling up physician practices” to quote the New York Times, or reportedly staffing 40% of hospital emergency departments.
Despicably, the administration has even used COVID-19 mortalities against nursing homes, knowing full well that studies show the unsparing lethality of the virus was “comparable” (indeed, slightly worse) in 2020 among those 65 and older in Medicaid HCBS care.
Last September, the administration’s demagoguery reached its crescendo with a proposed unfunded staffing mandate for nursing homes. It drew bipartisan concern, particularly from rural states. Gov. Sununu, Sens. Hassan and Shaheen, and Rep. Pappas were among those who signed letters of opposition — opposition shared by the American Hospital Association and National Association of State Veterans Homes, among other groups. Even the U.S. Small Business Administration questioned the proposal’s feasibility.
All concerns were brushed aside in the unveiling of the final rule — more onerous than that which was originally proposed — at a union rally in Wisconsin on April 22.
The administration purports to amend the statutory requirement that nursing homes have eight hours of registered nurse (RN) staffing each day and turn that into a 24/7 requirement. It’s inexplicable where these RNs are supposed to come from, given that, at last report, New Hampshire’s hospitals faced an RN vacancy rate of 17%, or over 700 full-time positions. Nor is it clear how nursing homes as small as 22 and 24 beds — such as two in Manchester that serve nuns — can fulfill such a one-size-fits-all mandate.
The rule also requires facilities to hire more licensed nursing assistants, even though they, too, are in critically short supply, and funding has run out for a program, NH Needs Caregivers!, intended to entice more Granite Staters into this front-line care profession.
This is why a survey of New Hampshire nursing homes revealed most could only meet the mandate by using staffing agencies or denying admissions to increase their staffing ratios. The first option would put strangers by the bedside at ruinous cost. The second would deny access to vital care, and, in so doing, also exacerbate the inability of hospitals to discharge to the nursing home setting, which is already a critical problem.
On the day the final rule was announced, the Hillsborough County Nursing Home had a wait list of 120 prospective residents as it, like other nursing homes, struggled to fill positions within finite Medicaid means.
Simply put, even with nation al data showing nursing homes raised wages an average of 26.5% between February 2020 and this January, there are not enough licensed workers to meet new unfunded federal expectations. The state has committed to pay nurse staffing agencies up to $94 an hour to staff the New Hampshire Hospital and Glencliff Home, and the locations of the agencies contracted with for $11.5 million, with 14 of the 16 based out of state, cover the U.S. map.
With society aging, creating greater health care demands, there’s no reason to believe a marketplace of desperation when it comes to finding health care workers will magically improve with a new mandate. Had President Biden participated in the New Hampshire primary, he might know there are no RNs in, say, Coös County sitting idly by the phone waiting for his mandate to give them job opportunities with nursing homes already staggering financially due to Medicaid underfunding.
Instead, the President decided sacrificing the future of nursing home care is worth whatever points he might score through political rhetoric. We can only hope Congress, or the courts, block a care-destroying rule that falls well outside administrative authority.
Brendan Williams is the president and CEO of the New Hampshire Health Care Association.
