Nursing home workers and educators pushed back on the administration's staffing mandate at a Senate Aging Committee hearing Tuesday, as the industry waits for the final rule to drop.
In September, CMS proposed staffing ratio requirements for long-term care facilities, which would require them to provide 0.55 hours of care from a registered nurse per resident per day and 2.45 hours of care from a nurse aide per resident per day. Facilities would also need to have one registered nurse on duty at all times. The proposal has been met with pushback from some lawmakers, as well as facilities, who argue there is not a large enough workforce to meet these requirements.
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Nursing homes are on the lookout for the final rule after the White House Office of Management and Budget finished its review of the regulation Monday.
"Our hope is that after [Tuesday's] hearing, more lawmakers will join the growing bipartisan opposition to this flawed mandate and urge the Biden Administration to reconsider," Clif Porter, senior vice president of government relations at American Health Care Association, said in a statement.
Senate Aging Committee Chair Bob Casey (D-Penn.) said long-term care providers have reported severe staffing shortages that hurt their ability to care for patients or, in some cases, stay open. Other senators expressed concerns that strict staffing ratios could lead facilities to close their doors.
"My fear, of course, is that if you change the staffing ratios in an environment where a lot of these facilities are already labor constrained, you might actually lead to closures," said Sen. J.D. Vance (R-Ohio).
Brooke Vogleman, a licensed practical nurse for Indiana-based TLC Management Senior Living, told the senators that adding more bodies to the workforce will only go so far. She said support for training long-term care workers is needed to reduce turnover rates.
"I think that it's not necessarily the amount [of staff] in numbers that gets us through the shift," Vogleman said. "It's...the ability that the team has to work together and provide a strong team that is dedicated, and compassionate, and going to be readily there when needed."
Some witnesses told lawmakers a state-by-state approach to staffing could work better than a federal requirement, as staffing needs can vary by location.
"Working with our local stakeholders has been very beneficial and giving us an opportunity to understand the specific needs of the various service regions that we serve," said Matthew Connell, sector vice president for healthcare for Ivy Tech Community College in Indiana and witness at the hearing. "Being able to customize our approaches to meet those specific needs has been very helpful."
Several long-term care workers testified to high staff turnover rates due to long hours, insufficient wages, a lack of benefits, low overall staffing and a significant growth in the number of people needing long-term care.
The nursing home staff and educators suggested state or federal initiatives on increasing staff wages and benefits, as well as changes to technical or training programs. Some suggested state or federal education funding for individuals interested in joining the long-term care field.
Casey raised concerns about long-term care workers' pay.
"In 2022, the median wage for [long-term] care workers was just above $15 dollars an hour, well below what is paid for warehouse and convenience store jobs," said Casey in his opening statement. "The [long-term] care workforce, the majority of whom are women of color, are more likely to live in poverty compared to the general public."
He pointed to the Long-Term Care Workforce Support Act, which he introduced with Sens. Tim Kaine (D-Va.), and Tammy Baldwin (D-Wis), as a way to tackle issues facing long-term care staff.
The legislation seeks to address training and access to training, as well as wages and benefits, with specific support for women, people of color and those with disabilities.