A controversial effort to mandate minimum staffing levels for nursing homes would be halted under legislation a congressional committee approved Wednesday.
President Joe Biden announced the initiative during the State of the Union address in 2022 and the Centers for Medicare and Medicaid Services issued a proposed rule to carry it out last September. The nursing home industry strongly opposes the policy, which has generated less than vigorous public support.
Related: CMS’ proposed nursing home staffing mandate explained
On Wednesday, the House Ways and Means Committee advanced the Protecting American Seniors’ Access to Care Act of 2023, which would bar CMS from finalizing the regulation, on a 26-17 vote. Democratic Rep. Terri Sewell (Ala.) joined all of the panel's Republicans in support of the measure, while the remaining Democrats voted no.
The CMS nursing home staffing proposed rule would require skilled nursing facilities to provide at least three hours of nursing care per resident, per day, with at least 0.55 hours by registered nurses and at least 2.45 hours by nurses aides. At least one registered nurse would have to be on duty at all times. Most nursing homes would have to comply within three years, while rural facilities would get five years. Limited exemptions would be available.
Before the vote Wednesday, Republicans characterized the nursing home staffing regulation as unrealistic and costly, and cited the nursing home industry position that a worker shortage makes the policy infeasible and that the extra labor costs would cause facilities to shutter.
"This rule won’t result in better care for seniors—quite the opposite," Ways and Means Committee Chair Jason Smith (R-Mo.) said. "Nursing homes around the country will be forced to downsize or close their doors for good. In just the last four years, over 400 nursing homes have shut down. How can we not expect more to follow, when the administration is about to place a giant $40 billion unfunded mandate on nursing homes and seniors?"
Democrats described the staffing mandate as key to improving quality of care in nursing homes and noted that CMS made allowances for small and rural facilities in its proposal.
Rep. Lloyd Doggett (Texas), the top Democrat on the panel's health subcommittee, blasted the legislation and dubbed it the "Abandon Nursing Home Residents Act" ahead of the vote Wednesday.
Moreover, Doggett contended that nursing homes would be able to afford more clinical employees if the private equity investors and corporations that own many of them invested in the facilities rather than cut costs to boost profits. "They come in, they suck out the funds, they cut the staff," he said.
Doggett also faulted nursing home companies for poor treatment of employees and low pay, which he blamed for recruitment and retention shortfalls. "Nursing homes have the funds to create better working conditions and attracting more workers," he said. "While qualified workers are available, they are not willing to accept minimal wages, no benefits and insufficient support."
The House committee action may prove little more than symbolic, even if the majority GOP House takes up the measure.
The Senate companion bill has attracted little backing and no committee attention since Sen. Deb Fischer (R-Neb.) introduced it in December. Just nine other senators have signed onto the bill, including Democratic Sens. Joe Manchin (W. Va.) and Jon Tester (Mont.) and independent Sen. Angus King (Maine), who caucuses with the Democratic majority. Sen. James Lankford (R-Okla.) is the only cosponsor who sits on the Finance Committee, which has jurisdiction over the issue.
The American Health Care Association/National Center for Assisted Living applauded the Ways and Means Committee vote.
"This rule will do nothing to improve quality or grow our workforce, but instead displace hundreds of thousands of residents. We are eager to work with members of Congress and the administration on more constructive policies and programs that will help nursing homes recruit and retain a strong pipeline of caregivers,” AHCA/NCAL Senior Vice President of Government Relations Clif Porter said in a news release.
The AARP, the Service Employees International Union, the AFL-CIO, National Consumer Voice for Quality Long-Term Care, the National Committee to Preserve Social Security and Medicare, and other organizations opposed the Protecting American Seniors’ Access to Care Act of 2023, Doggett said.
