Toumpas: Federal staffing mandate a bad deal for New Hampshire seniors
New Hampshire, we have a problem. We’re living longer and a “silver tsunami” is well on its way. The state’s population, already one of the oldest in the country, is growing. At the same time, the number of high school graduates is expected to continue falling. Fewer graduates means a shrinking pool of home-grown talent willing to enter the healthcare workforce. We are on a demographic collision course.
Policymakers need to get serious about care for our seniors as our current system does not have adequate resources to handle the inevitable surge in demand. Our healthcare workforce needs rebuilding – particularly those trained to work in nursing homes. The last few years have made our challenging situation worse, as the pandemic pushed our existing hospital and nursing staff to their breaking point. Today, staffing shortages have reached unprecedented levels in long term care facilities, but the Biden administration is going in the wrong direction to help fix it.
An unfunded federal staffing mandate for nursing homes is expected to come down from the administration soon. While the goal of increased quality is admirable, to impose an arbitrary staffing ratio on facilities in the name of improving quality ignores reality. Never mind the fact that a study commissioned by the Centers for Medicare and Medicaid Services (CMS) found that no staffing level would guarantee quality of care – all signs point to the administration intending to move forward.
It seems that the underlying assumption of the administration’s proposal is that nursing homes just aren’t hiring. If they mandate that nursing homes hire more people, the problem will be solved. Clearly, nobody wants to hire more nurses and caregivers than our nursing homes. The challenge is that there aren’t enough prospective job candidates who meet the necessary qualifications. Nationally, 72 percent of nursing homes say their staffing levels are lower than they were before the pandemic, even though 90 percent have increased wages in the last six months.
Yet as they try their best amid a historic workforce shortage, the administration wants to compound these challenges by forcing a rigid regulation on them that will require thousands more workers. More than 100,000 nurses and nurse aides are needed for nursing homes to meet this new staffing rule, but they won’t see any new federal dollars to help achieve this. Given labor market conditions and no new resources, it shouldn’t come as a surprise that 89 percent can’t meet it.
Access to care for New Hampshire seniors is becoming increasingly challenging for families in need of long-term care for loved ones. Facilities are turning away new patients, taking beds offline, downsizing, or closing units. Reliance on staffing agencies has become a standard practice, which is much more expensive for underfunded nursing homes than hiring full-time employees. Other nursing homes are buckling under the staffing pressure and closing completely. If anyone thought the situation was bad now, it’s only going to get worse under the mandate. It’s also important to note that our facilities operate as a system; When one fails or reduces capacity, it puts increased pressure on neighboring facilities.
Fortunately, bipartisan opposition on Capitol Hill is growing – which should tell us that this isn’t about politics. It’s just a bad policy that will hurt our most vulnerable. CMS has received over 40,000 comments from the industry, the vast majority of which are against the proposed rule.
The House Ways and Means Committee just passed legislation that would block the rule from becoming final, while companion legislation in the Senate has a strong list of Republican and Democrat cosponsors. New Hampshire’s federal delegation, including Representative Pappas, are among many Members of Congress to point out the rule’s inherent red flags, while local leaders are starting to take note, too. Last month, the Portsmouth City Council passed a resolution opposing the mandate because they understand the detrimental impact it will have on access to care.
A counterproductive federal mandate is not what our nursing homes need. Policymakers in Washington must redirect their focus on solutions that strengthen the nursing home workforce and acknowledge the realities they are facing. As the demand for long-term care services continues to increase, we need to make sure the supply of skilled workers keeps pace.
Nick Toumpas served as Commissioner of the New Hampshire Department of Health and Human Services from 2007 to 2016. Toumpas is a resident of Rye, and currently serves as a member of the Community College System of New Hampshire Board of Trustees.