Long-term care providers warn impending Biden regulations threaten viability
Less than a month before new federal nursing staff requirements take effect, long-term care providers reiterated their bleak warning that many North Dakota facilities will not be able to meet the Biden administration mandate. The regulations come at a time when many nursing homes and other providers already face a dire shortage of workers, making it a practical impossibility. The extent of concern came through loud and clear in a recent state legislative hearing covered by Inforum on the impact of implementation.
Medicare- and Medicaid-certified facilities will be required to have a registered nurse on site 24/7 and increase the number of nurse aids available daily. Rural communities have a year longer to implement the standards than urban communities. Proposed last September and finalized in April, the rule received over 46,000 comments during the 60-day national comment period that closed in November.
“This rule does not only impact nursing facilities, it will impact all sectors of health care and the cost of care in our state,” Nikki Wegner, president of the North Dakota Long Term Care Association, testified in a state Health and Human Services committee meeting on Thursday, July 11.
It’s difficult to overstate the gap between the the federal government’s mandate and the shortage of workers available to make it a reality in North Dakota.
According to the Bureau of Labor Statistics, North Dakota would need to add 1,313 nursing home workers to return to pre-pandemic levels. Data from the Payroll Based Journal indicates 79% of the state’s facilities would not comply with the registered nurse mandate and only 17% would meet nursing requirements.
The same data shows rural communities in the state would be disproportionately impacted, where 86% wouldn’t meet requirements compared to 65% in urban areas. North Dakota would have to spend a minimum of $4.5 million per year to comply.
Even if there were enough available RN’s to go around to meet the mandate, some question the need for them 24/7.
Rep. Kathy Frelich, R-Devils Lake, responded to Wegner’s testimony, referencing her professional experience with long-term care as an outreach specialist at the North Dakota School for the Deaf and Resource Center for Deaf and Hard of Hearing.
“I would say that quality of care generally isn’t related to your RN. It’s usually related to your CNA (Certified Nursing Assistant) on that level. So, I’m concerned that this is just adding a cost,” Frelich said. “Ultimately, that goes back to the residents.”
Long-term care residents pay an average of $403.19 per day — over $12,000 monthly — a rate Frelich said would “drastically” increase.
Republicans in the House of Representatives have challenged the staffing requirements under the Congressional Review Act. Yet the onerous nursing regulations remain on track to take effect on August 8.
Rep. Kelly Armstrong, R-N.D., and 33 other Republicans cosponsored a joint resolution of congressional disapproval introduced by Rep. Michelle Fischbach, R-Minn., in May. Additionally, Sen. Kevin Cramer, R-N.D., sought to delay the rulings by introducing the VA Report on Proposed CMS Staffing Ratios Act, which would require the Veterans Association to study the risks to elderly veterans posed by the new requirements.
Some facilities may be able to apply for an exemption under certain conditions. But right now, the only thing potentially standing between providers and implementation of this onerous federal mandate is an American Health Care Association lawsuit filed against the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.