New nursing home staffing rule concerns senators

BUFFALO — In response to a new rule from the Centers for Medicare & Medicaid Services that they say could devastate rural nursing homes, Wyoming Sens. John Barrasso and Cynthia Lummis joined their colleagues in introducing a Congressional Review Act resolution of disapproval to overturn the agency's rule.

The new rule is intended to improve patient care by ensuring minimum staffing requirements, but in a joint press release, the senators said that the rule could have dire consequences for rural nursing homes because the facilities will not be able to meet the staffing requirements.

“Due to these shortages, nursing homes across rural America will struggle to remain open, and many will be forced to close their doors, leaving entire communities without access to these essential senior services,” the press release said.

Though the rule doesn't go into effect in rural areas until 2029 – and Johnson County Healthcare Center CEO Luke Senden is hopeful that the rule will be overturned – the rule does raise real concerns for the operations of the Amie Holt Care Center.

That's because the facility doesn't have the staff to meet the Biden administration's new staffing rule.

"Sen. Barrasso's office showed a lot of their understanding of the threat," Senden said. "We're not the only ones sitting here nervous about our ability to keep our doors open if this goes forward.”

The new rule requires that nursing homes have a registered nurse on duty 24 hours a day, seven days a week.

"I can't even imagine what that is going to do to the nursing home industry,” Brenda Gorm told the Johnson County Healthcare Center's hospital board. Gorm is the Amie Holt Care Center's director.

In an interview with the Bulletin, Gorm said that while the staffing requirements would certainly drive up the cost of care, “my concerns are staff related. My concern is that we would have to hire three additional RNs and we rarely have an RN applicant.”

Gorm said that the care center had staffed the facility – particularly overnight – with licensed practical nurses with 20 years or more of experience who are "perfectly capable. I think it's an insult to think they can't do it."

Gorm said that the rule also requires that a certain number of direct care minutes be provided to each resident daily by a nurse's aide, but that she is less concerned about the facility's ability to meet that requirement.

The Centers for Medicare & Medicaid Services' current staffing rule requires a licensed nurse of any level on duty around the clock and sets standards for patient care but leaves staffing specifics up to each facility's discretion. The new rule, which is set to take effect in 2029 in rural sites, requires a registered nurse to be on duty 24 hours a day, seven days a week in case of a patient crisis. Each patient must receive 33 minutes of care a day from a registered nurse and 147 minutes of care from a nurse aide. Facilities could request “hardship” exemptions if they met several requirements.

Experts estimate that only one in five nursing homes meets the new staffing requirements.

Gorm understands that the spirit of the law is to ensure that long-term care center residents are well cared for. But the rule fails to account for the reality of providing care in small, rural care centers, she said.

“The intentions are good, but it will leave nursing home residents without a place to live,” she said.

That's because the costs associated with the staffing requirements could make long-term care impossible for families to afford.

Senden said the requirements would drive up the cost of care – perhaps to the point that providing long-term care is not economically feasible.

“Another huge aspect is there is a cost component, and I think everyone is upset at how much it costs to run a nursing home,” Senden said. “This is going to drive the cost up across the country and really make it unsustainable to provide nursing home care.”

Senden said that because there is some time before the rules are implemented in rural care centers, the focus has been on overturning the rule.

“We have some concerns with what it could be,” he said. “We have some time, and I think there are more efforts right now to stop it rather than on how to manage it. We're kind of hopeful that some of these other things would stop it from going into effect.”

This story was published on June 20, 2024.\