By Steve Moran
This is the first article in a three-part series on staffing mandates. See part 2 here and part 3 here.
A few weeks ago the federal government announced the long-anticipated/dreaded staffing mandates proposal. Since the first announcement I have been reading the commentary coming out of the industry, and it is universally critical for a lot of valid reasons.
And yet …
AHCA has taken a hard position that not only are these staffing mandates a terrible idea, but that staffing mandates as a concept is a bad idea. LeadingAge has taken a more nuanced position, not quite supporting staffing mandates but also saying we need to get the staffing thing right.
The idea that we should have no staffing mandate is dumb.
It Makes The Industry Look Bad
In the eyes of the public: When the public sees the industry opposes any and all staffing mandates, their already negative view of our industry is reinforced. It sends the message that profits are more important than people, that the only thing that matters is profits.
In the eyes of frontline workers: Most communities run as lean as they can when it comes to care staff. They do this to control costs and because finding enough staff is a huge challenge. This means that the lowest paid people in every community are the ones paying the biggest emotional/mental health price for the crisis and making the least amount of money.
Opposing staffing mandates of any kind sends the message that owners and operators don’t care about team members, they don’t care about residents.
As of the date this was written there are nearly 5,000 public comments. Here are some randomly selected ones supporting the mandates. It appears there are many more comments supporting the mandates than opposing them.
LTC facilities needs more staffing in all departments. The facilities need adequate staffing to ensure the residents are given proper care and to provide safety for the residents and staff.
I support a strong minimum staffing standard that is equal to or above 4.1 hours of direct care by day.
— https://www.regulations.gov/comment/CMS-2023-0144-0236
As a housekeeper in a nursing home, I hear and see how much the aides hard work they do and residents suffer for the long wait when their call lights are on because the aides take care of another residents, because there arent enough aides. Food gets cold because theres no other staff to feed him/her when the staff that is assigned to that room is feeding another person. Therefore, the residents dont want to eat cold meals and affects wellbeing or health.
— https://www.regulations.gov/comment/CMS-2023-0144-0269
We have some residents currently who havent had a shower in over a week over two or three weeks, even. This is mainly due to understaffing, but a lack of spending on adequate supplies is also to blame when we dont have the hot water or wash cloths we need. Right now, the only way for our residents to get showers is if staff like me choose to miss our breaks and even our meals instead. Thats the choice: showers for residents or breaks for staff.
— https://www.regulations.gov/comment/CMS-2023-0144-0254
The Center for Medicare & Medicaid Services,
The nursing home industry has a reputation, probably deserved, for under-staffing. With an aging population, it is essential that these facilities be staffed sufficiently to take care of our elderly. Some day, I may be one of them (I’m 85 and counting).
— https://www.regulations.gov/comment/CMS-2023-0144-1593
The very fact that the Nursing Home Administrators are fighting this, just verifies that their primary concern is for the bottom line rather than the care and safety of people. IF their priority were for those under their care, no one would have to be demanding minimum staffing, and it should be noted that the demand IS for minimum, not optimal staffing. In many homes family and friends often must provide care to ensure basic needs are met, such as feeding those, who are unable to feed themselves, and wheeling people to the dining room, for those who are unable to ambulate.
It is reasonable for family members to expect the bare minimum of care be provided for their family members. It seems to me that it is reasonable for them to expect that safety, and care be the first priority of the facilities in which their family members are placed. Those opposing these minimal changes should be ashamed, and perhaps be investigated for working to systematically prevent those in their care from having the basic care they need to thrive.
A couple of additional observations about these comments: As you read through these and other pro comments you will find some similarities that are a clue that they were submitted as part of a campaign by various interest groups. This will also be true of the comments opposing the mandates.
Reasonable Staffing Mandates
No airline can fly unless they have the minimum numbers of pilots and flight attendants, and I promise you that not a single senior living executive would be in favor of eliminating that staffing mandate. Same thing for trains. Child care centers all have minimum staffing requirements; no one thinks that is a bad idea. Reasonable mandates are good for the industry, good for team members, and most importantly, they are good for residents. They will even be good for owners and operators.
Lead or Follow
Post-acute providers have gotten used to having things done to them rather than leading the pack. Hospitals on the other hand have mostly been in charge of their destiny by staying out in front of threats. They tell stories about changed lives. They lobby like crazy. They also recognize that some regulation is inevitable and even good. Rather than fighting everything, they support regulation that works for them instead of against them.
The industry has this unique opportunity to say, “Staffing mandates are good for residents, good for families, and good for team members. Here is what they should look like, and we are going to fight for the right kind of staffing mandates.”
More on this in a future article in this series. Subscribe to Foresight here so you don’t miss a post.
