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‘Moment of decision’ seems close to the personnel rule for nursing homes

A two-day wave of legislative action against the nursing home workforce mandate has left some staunch supporters of the requirements feeling “very concerned” about the future of the rule.

Since late Tuesday, when hundreds of long-term care providers and their advocates took to Capitol Hill, federal lawmakers have introduced a bill in the Senate that could effectively repeal the regulations. They also called for a new study of the rule’s effect on veterans’ homes.

At a quickly assembled press conference Wednesday, Reps. Jan Schakowsky (D-IL) and Lloyd Doggett (D-TX) joined union members and leaders from AARP and Consumer Voice in hoping to pressure more Republicans to pass a pro-mandate point of view to embrace.

Doggett said he was “very concerned” about the formal introduction Tuesday evening of a bill in the Senate calling for a congressional review of the rule published May 10 by the Centers for Medicare & Medicaid Services. About 30 senators, most of them Republicans, signed the resolution. of disapproval, including sponsor James Lankford (R-OK) and Jon Tester (D-MT).

Tester had promised attendees at the American Health Care Association’s Congressional Briefing on Monday that the bill — supplementing a House resolution calling for review — would be introduced soon. If both bills are passed within 60 days of the CMS rule being published, they could overturn the CMS rule. But the final bill would require a signature from the president, or enough votes to override a veto.

The House version, Doggett said, had already passed out of the Ways and Means Committee on a party-line vote.

“It’s only a matter of time before this hits the ground, and it will be very close,” Doggett warned.

Nursing home advocates said this week they hoped that getting enough votes in Congress for the disapproval could convince President Biden not to veto it. But they are also pursuing other legislative remedies and a federal lawsuit alleging that CMS exceeded its authority in setting minimum hourly direct care rates and adding a new requirement for 24/7 coverage for registered nurses.

‘No shortage’

Schakowsky and Doggett argued that there is no direct care workforce crisis.

“The workers who are with the residents of nursing homes say they want to be there. They want to have enough people to take care of everyone, and there is no shortage of people willing to do the work — except they have to be paid a decent wage,” Schakowsky said. “But we also see that there are nursing home owners who want to reduce the number of people they pay into nursing homes.”

Schakowsky attacked private equity investments in the sector, which have been shown to account for approximately 5% of all facilities. Doggett, meanwhile, criticized the industry’s historic profit margins and failed to address COVID cost pressures, inflation and labor demand. He acknowledged there is no funding to support the rule, which is expected to cost providers between $4 billion and $7 billion a year.

“If the nursing industry can claim that it lacks the funds, despite all the research showing the profits they are making, we would be willing to get to work to ensure the funds are made available,” Doggett said.

Two separate bills calling for major long-term care workforce initiatives — and funded with billions of dollars — have yet to gain broad support among lawmakers.

This disconnect is one reason why AHCA and LeadingAge joined forces with a broad coalition of other senior care providers to demonstrate how the workforce rule threatens seniors’ access to care.

‘Unsustainable’ pressure on vets’ homes

Much of the focus at Wednesday’s event was on employees, but a new Senate effort shows lawmakers remain concerned about the long-term impact on residents should facilities be unable to comply with CMS mandate.

Sens. Kevin Cramer (R-ND) and Angus King (I-ME), members of the Senate Veterans Affairs Committee, announced late Tuesday that they had asked VA Secretary Denis McDonough to prepare a report on the impact. The letter is in conjunction with legislation that senators have drafted that would require the same thing.

“Long-term care facilities in Maine, North Dakota, and across the country have struggled to recover from the post-pandemic – we cannot simply create a new pipeline of health care workers, and without staff to fill the required positions, we are left with ​many facilities on the verge of closure,” the senators wrote. “Simply put, we are concerned that long-term care facilities, including those serving veterans, may not be able to meet the new staffing requirements. …we have serious concerns that the industry will not realistically be able to achieve the objectives of the Rule, let alone prevent massive widespread closures.”

At a separate event following AHCA’s Congressional Briefing Tuesday, Melissa Jackson, liaison officer for the National Association of State Veterans Homes, highlighted the challenges facing those who serve veterans. More than 150 state facilities serve approximately 14,000 veterans.

Vermont Veterans’ Home administrator Jackson has a waiting list of 60 vets due to staffing shortages. Where she once admitted a new resident two or three times a month, she now, if she is ‘lucky’, admits a new resident about once a quarter. Even though $11 million is spent annually on staffing agencies to get nurses and other nurses on site.

“This is unsustainable,” she said. “Veterans need skilled care and we are struggling to keep our facilities open. Demand will only increase and the mandate does not improve this situation. It’s not just about filling vacancies. It’s about ensuring our veterans have access to the care they need and deserve.”

Jackson asked lawmakers to look for comprehensive solutions that address the labor and funding elements necessary for workforce advocacy.

However, consumer advocates continue to send the message that the only way to improve care is to support the CMS minimum staffing standard.

“These are final rules,” Megan O’Reilly, AARP vice president of government affairs, said Wednesday at the event outside the Capitol. “Any attempt to weaken them would take something away from the residents and staff.”