The federal government wants to require nursing homes nationwide to boost nursing staff levels, including in Missouri. A proposed rule would require a minimum of 2.45 hours daily per resident for nurse aides, a minimum of 0.55 hours daily per resident for registered nurses, and a registered nurse on site 24 hours per day, 7 days a week.

The federal government says the requirements would allow older Americans to age with dignity and provide people with disabilities with high quality care. It says the requirements will hold nursing homes accountable and make sure that residents get safe care.

A group representing about 350 Missouri nursing homes is pushing back on the proposal. Nikki Strong, executive director of the Missouri Health Care Association, said the proposed federal rule does not include additional federal funding.

“Looking at the total number of folks that they would need, we’re looking at almost 4,000 more individuals that we would need to be able to meet that mandate. And these people just don’t exist,” said Strong. “You can’t find bodies. You can’t find people to come and fill these positions. So, this isn’t a matter of – it’s twofold. A, we need the money to be able to pay for them, but B, we need the people to be able to pay to fill the positions.”

She said the plan would “decimate” the state’s nursing homes.

“You know, we’ve had several facilities close in rural areas, many because they can’t find staff now. This is happening at a certain level,” said Strong. “It’s been a slow trickle. If this rule will go into place, the slow trickle would stop, you know this will be a full flood gate of closings, I’m afraid, and it would hit the rural areas faster.”

According to Strong, analysis of Medicare cost reports for Missouri nursing homes shows that the cost from the proposed staffing rule to Missouri locations would be $198 million annually based on average hourly rates. She said Medicaid is a significant payor for services in the state of Missouri, making up nearly three-fourths of the funding to facilities.

Strong said Medicaid funding to Missouri sites has been chronically underfunded, with a current average shortfall of about $50 per patient per day between the funding Missouri locations receive through Medicaid reimbursement and the costs to provide those services.

“Nursing homes strive to provide quality care and have the appropriate staff to care for those folks. If they don’t, they halted admissions until they do have the staff. But proposing an unfunded mandate is not what’s going to turn around and provide quality care. Instead, it’s going to create access issues, close facilities and people will not be able to access the care,” she said.

The proposed rule applies to nursing homes that are Medicaid or Medicare certified locations – not assisted living locations, hospitals, or any other healthcare setting. According to Strong, about 496 facilities would be subject to this federal proposal.

“That impact trickles down to hospitals and other healthcare settings,” she said. “A lot of our admissions come directly from the hospitals. Hospitals care for somebody and realize they either need short term rehab or are too sick to be able to go back home and need a facility to go into. But with this, folks would have nowhere to go. I think any healthcare provider should be concerned if the federal government is going to come in and dictate to nursing facilities. I think any healthcare provider should be concerned that they are going to be next. If this goes into effect, we’re going to be drawing from the other healthcare providers, in order to try to meet the mandates or they’re going to go out of business.”

Fifteen Republican governors, including Gov. Mike Parson, have sent a letter to President Biden, asking him to reconsider the rule. The governors say the long-term care industry is facing a workforce crisis, especially in rural areas, and the group calls the agency’s proposal an unnecessary, one-size-fits-all requirement that will force many long-term care facilities to close.

“When you dig down into the rule, if you look at it just conceptually, I understand where people think it’d be wonderful. But we look at the rule and the inability to meet so many criteria within that rule, there is nothing I can look at this and say, ‘This is a good idea for the state of Missouri and the quality of care that we provide in our facilities.’”

Strong said about 43,000 responses have been posted about the proposal. Now the federal government can decide whether to change the rule as a result of the responses.

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