Senior Care and the Death of Common Sense

Our federal government has lost common sense by adopting the same staffing requirement in every nursing home in the United States, and not paying for it!

Our nation’s largest association of long term and post-acute care providers, the American Health Care Association (AHCA), says the new staffing mandate for nursing homes and other Medicare- and Medicaid-certified long term care facilities (CMS 3442-F) will cost providers $6.5 billion a year.

That’s billion, with a B – but with no funding to pay for it.

More absurd, there aren’t any staff to hire. The AHCA estimates it would take 102,000 new employees to meet the national mandate – new employees who do not exist. And the shortage will get worse as Baby Boomers retire.

Registered nurses (RNs) are part of the mandate, are particularly scarce, and are retiring in record numbers. The mandate would require long term care facilities to have an RN in the building 24/7. That is unnecessary and we’ve never needed one. We’ve always had RNs on call; and now, with telemedicine, they can be on video 24/7. Technology works!

The RN requirement will be especially difficult for nursing homes, including Lutheran Services Carolinas’ nine skilled nursing facilities in North Carolina. First-shift RNs are hard enough to find without requiring in-person second and third shifts. Given the labor shortage, it’s not uncommon to have only one RN on duty. If they get sick or take vacation, we will be in violation. We don’t have replacement RNs sitting on the bench.

The madness continues. Licensed practical nurses (LPNs) provide most of the nursing services in a nursing home. Our federal government left them out of the staffing mandate. They only count toward a small percentage of “other” staffing.

One size does not fit all. There are nursing homes that provide complex, specialized care to subacute patients right out of the hospital. Other facilities look more like quiet rest homes. It all depends on the location, type of market, and who the nursing home wants to serve. The federal government already had a workable, fair rule that nursing homes must be adequately staffed for the residents they care for. Common sense. The mandate may not be enough staff for some nursing homes and too much for others, but one size is going to fit all.

Some nursing homes will be stuck between a rock and a hard place, and our seniors with them. The AHCA has determined over 290,000 vulnerable people – nearly a quarter of U.S. nursing home residents – may have to find new homes if facilities are forced to reduce their head count.

There’s always a good reason for regulations, mainly to set standards to protect the public. But there is always that person who wants to carry a good thing too far. The federal government already has adequate regulations in place. The federal government should punish the offender, not punish the residents and the entire profession.

The rule is bad, but it could be made less so with a few compromises: RNs could be on call, LPNs could be included, and there could be additional exceptions based on local circumstances.

Thankfully, the fight is not yet over. Congress is considering bipartisan legislation (Protecting America’s Seniors’ Access to Care Act, S. 3410/H.R. 7513) to stop the federal government from implementing the mandate. The AHCA and LeadingAge, our two national networks, have also filed a suit to stop it. Hopefully, one of these efforts will succeed.

Lutheran Services Carolinas’ vision is abundant living for all – and especially our seniors. We need a partner in government, not a millstone.

We can all help. If you see your U.S. Senator or Congressperson, please thank them for opposing this government overreach. If the effort to stop the mandate gains steam in Congress, we will ask you to advocate on behalf of our seniors. Stay tuned.

Thank you for your continued support of America’s seniors.

Ted W. Goins, Jr. is president and CEO of Lutheran Services Carolinas (LSC), a nonprofit direct care provider that serves over 2,500 seniors and over 7,500 children, families, international refugees, and other legal immigrants. Goins began his career on the front lines of care as a certified nursing assistant, served over 10 years as a licensed nursing home administrator, and spent three years in administration and development with LSC before being named President in 2000. He is active in a number of state and national organizations and holds an Honorary Doctorate of Humane Letters from his alma mater, Lenoir-Rhyne University. He also holds a Master of Science degree from Pfeiffer University.