By Irving Stackpole & John Sheridan in McKnights Long-Term Care News
The Centers for Medicare & Medicaid Services notice of proposed rulemaking and the report on which it is based have made the foundational point that more staff in nursing homes will result in better patient care and outcomes. While this relationship may seem self-evident, the actual data to support this axiom is pretty thin. But to dismantle the proverbial deck chair while the entire vessel is sinking will quickly lose everyone’s attention.
The issues with these proposed staffing mandates are multiple. First, the available supply at-large of both registered nurses (RNs) and nursing assistants (NAs) is inadequate to meet the proposed requirements. It is a key fact that the supply of RNs and NAs is inelastic; they cannot be manufactured overnight. There are not plenty of RNs and NAs on the sidelines and there’s no indication that, as soon as they see possible opportunity, the ones who left will come back to nursing home jobs.
There wasn’t enough supply before the pandemic, there are even fewer now, and it’s wishful thinking to build a plan on the fiction that they’re eager to return – especially for the same pay rate. Second, these unfunded mandates will drive many more nursing homes out of business. Nursing home providers will be punished or rewarded based on location, payment mix and other factors, which are irrelevant to nursing home quality.