Rédaction Africa Links 24 with David C. Grabowski and David G. Stevenson
Published on 2024-02-05 09:30:42
The Biden administration has proposed a minimum staffing standard for nursing homes, which would establish detailed federal nursing home staffing standards for the first time, requiring facilities to always have a registered nurse onsite and to meet explicit levels for RN and nurse aide staffing. However, this proposal has received intense criticism from both industry and advocacy stakeholders.
Industry stakeholders argue that the staffing requirement is an unfunded mandate that will lead to the closure of nursing homes due to thin operating margins and broader workforce challenges in hiring direct care staff. Meanwhile, advocates contend that the staffing requirement is too weak and will not protect residents, asserting that nursing homes have plenty of money to pay for staff, but they are hiding dollars through complex ownership structures and related party transactions.
The proposed rule has led to a contentious policy debate, with both sides expressing dissatisfaction with the proposal. However, researchers who study nursing home care have expressed concerns that each side is working from different sets of facts, making it difficult to engage in a meaningful policy debate about how to move forward.
Nursing home providers have been particularly vocal in opposing the proposed rule and have enlisted lawmakers on both sides of the aisle to oppose it altogether, with those from rural markets being particularly sympathetic to their concerns, highlighting the role of nursing homes in their communities and pointing to an insufficient labor supply of direct care staff.
Despite the opposition, the proposed rule explicitly acknowledges the challenges faced by rural facilities and offers exemptions for those facing a tight labor market. While the proposed rule is not perfect, it has the potential to compel much-needed change, according to researchers and policy experts.
Nursing home care relies on having adequate staff to meet the needs of residents, including help with daily activities and complex medical needs. However, the current debate about staffing has resulted in both industry leaders and advocates talking past one another, with conflicting claims about the financial capabilities of nursing homes.
The administration has also taken steps to improve transparency in nursing home ownership and management entities, targeting private equity, real estate investment trusts, and other investors in the sector. However, these efforts have been hindered by incomplete, outdated, and unreliable data, leaving policymakers without the necessary information to address the issue effectively.
A recent National Academies of Sciences, Engineering, and Medicine (NASEM) report made recommendations to improve the quality of nursing home care, emphasizing the need for increased transparency and accountability in finances, operation, and ownership. The report recommended collecting and making publicly available detailed facility-level data on the finances, operations, and ownership of all nursing homes, as well as ensuring that accurate and comprehensive data are available in a real-time, readily usable, and searchable database.
In conclusion, the need for more staff in U.S. nursing homes is widely recognized, but meaningful staffing standards are difficult to implement without greater transparency and accountability. With better data in place, policymakers could break the stalemate and improve the care of millions of baby boomers who will receive nursing home care in the coming years.
