Newly issued nursing home staffing mandate roils Republicans

U.S. Sen. Deb Fischer (R-NE) and U.S. Reps. Cathy McMorris Rodgers (R-WA) and Adrian Smith (R-NE) denounced a final rule issued on April 22 by the Centers for Medicare & Medicaid Services (CMS) that sets minimum staffing requirements in long-term care facilities.

“The president’s one-size-fits-all, Washington-knows-best approach to long-term care is an unfunded mandate that will drive up costs and threaten access for patients,” Rep. McMorris Rodgers said. 

The “Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule” aims to hold nursing homes accountable for providing safe and high-quality care for the nearly 1.2 million residents living in Medicare- and Medicaid-certified long-term care (LTC) facilities. 

Central to the final rule are new comprehensive minimum nurse staffing requirements, which will reduce the risk of residents receiving unsafe and low-quality care within LTC facilities, according to CMS. 

However, the Republicans, who each issued separate statements, say the final rule will hurt LTC facilities across rural areas of the country and could force many to close.

“Time and again, this administration has abandoned rural America, leaving working families and small businesses in the dust,” said Sen. Fischer. “Instead of listening to the overwhelming, bipartisan opposition to this rule, the administration has decided to plow ahead. This misguided rule will devastate nursing homes across this country and worsen the staffing shortages we are already facing.”

Rep. McMorris Rodgers added that the minimum staff-to-patient ratio is unworkable for nearly 80 percent of nursing homes, requiring facilities to increase costs for patients or close their doors to new patients. 

“The so-called ‘access rule’ creates untenable standards for home health agencies to meet,” said the congresswoman. “Both rules in practice will result in reduced access to care for those that need it most and their families.”

Rep. Smith pointed out that nursing home closures are disproportionately impacting rural areas, including Nebraska’s Third District, which he represents. Workforce shortages there have increased pressure on facilities that are struggling to fill vacancies, he said.

“Arbitrary staffing ratio mandates like the one CMS finalized today are sure to put more communities at risk of not having access to a local facility at all,” said Rep. Smith on Monday. “Rather than piling on regulations, the Biden administration should be promoting innovative solutions to build up the workforce, such as extending successful staffing flexibilities implemented during the COVID-19 pandemic.”

Rep. Smith is a cosponsor of the Protecting America’s Seniors’ Access to Care Act, H.R. 7513, which would block implementation of the nursing home staffing mandate. The measure is related to the bipartisan Protecting Rural Seniors’ Access to Care Act, S. 3410, which Sen. Fischer sponsored in December 2023.

Sen. Fischer’s bill would prohibit the U.S. Department of Health and Human Services from finalizing the rule and would establish an advisory panel on nursing home staffing to identify better solutions. Her legislation has been endorsed by more than 90 organizations, including the American Hospital Association, the American Health Care Association, and the National Organization of State Offices of Rural Health, among many others.

Both bills remain under committee consideration in their respective chambers.