AHA, AHCA Issue Joint Letter to CMS Outlining Staffing Mandate Concerns

Nursing homes are already struggling to hire enough staff for efficient and safe operations, so a potential staffing mandate wouldn't be helpful.

The American Hospital Association (AHA) and American Health Care Association (AHCA) sent a joint letter to the Centers for Medicare and Medicaid Services on Monday expressing their concerns about the proposed federal staffing mandate.

CMS introduced the proposed rule earlier this year, which would require the nation's nursing homes to have a set number of workers on staff. The healthcare sector as a whole is struggling amid an historical workforce shortage, aging services providers in particular, and the proposed mandate would do more harm than good, according to the letter

"We anticipate many nursing homes will be forced to further reduce their capacity and even close their doors if they are unable to meet these staffing mandates," the letter stated. "This would accelerate the domino effect across the entire continuum of care and leave vulnerable seniors with fewer care options."

In the letter, addressed to CMS administrator Chiquita Brooks-LaSure, the AHA and AHCA note that nursing homes lost 210,000 workers from February 2020 to December 2022—the most of any health sector. While there has since been some "modest" growth, it's estimated that nursing homes won't return to pre-pandemic staffing levels until 2027.

"Furthermore, mandating staffing levels is a simplistic, one-size-fits-all approach to the needs of complex and unique nursing home residents and patients," the letter stated. "In short, specific staffing levels should be a clinical decision customized to the resident population and facility characteristics rather than a policy decision made with lack of regard to real-life situations."

The AHA and AHCA urge CMS and policymakers to consider other ways of addressing the workforce shortage, even if they take longer to remedy the situation. Some suggestions the organizations provided include:

• Augment the depleted workforce with foreign workers, with Congress creating a temporary visa option for RNs, certified nurse assistants, and other needed roles.
• Support apprenticeship programs for nursing assistants and other critical support staff roles  to develop a pipeline of workers with customized skills and improve employee retention and employer reputation.
• Pass the Building America's Healthcare Workforce Act which would extend flexibility given to nursing homes during the public health emergency, allowing nurse aides to remain in their roles beyond the required four months and for their additional time to be applied toward their CNA training.
• Adopt policies that would expand loan repayment and incentive-based programs to retain existing talent and attract new talent.
• Direct the Government Accountability Office to study business practices of travel nurse staffing agencies during the pandemic, including high prices and excessive profits, and how they contribute to the workforce shortage.