Research Flags “Concerning” Employment Losses At Nursing Homes Amid Biden Administration Staffing Push

By Susanna Vogel of HealthcareDive

Summary:

• Healthcare employment growth fell across the board during the COVID-19 pandemic. Some sectors have had more difficulty rebounding than others, according to a new study — especially skilled nursing facilities, which face a controversial federal push for more staffing.

• Employment in hospitals increased 0.4% per quarter before the pandemic, but that growth rate shrunk to 0.03% during COVID-19, according to the study published in JAMA. By comparison, employment at skilled nursing facilities was already declining before COVID, dropping at a rate of 0.2% per quarter. During the pandemic, the rate of job losses accelerated to 1.1%.

• The Biden administration is seeking to impose mandatory nursing staffing minimums at skilled nursing facilities, or SNFs. The nursing home industry largely opposes the rule, arguing there are not enough workers available to meet the staffing mandate.

The downward employment trend in SNFs is “concerning,” according to the study’s authors, who said it could be due to a variety of factors, including worker worries of contracting infectious diseases, lower wages and high turnover among long-term care occupations.

Regulators, healthcare industry leaders and workers unions disagree on how to make such roles more attractive to workers.

In September, the Biden administration proposed a rule that would require nursing homes to provide three hours of nursing care per resident per day. The proposed rule also stipulates that at least one registered nurse be on duty at long-term care facilities at all times.

Supporters of the rule, including top Biden administration officials, say that increasing staff is associated with higher-quality patient care and lower levels of provider burnout and turnover.

Critics, including nursing homes and lawmakers on both sides of the aisle, have asked the CMS to scrap the proposed rule, warning that requiring the industry to comply with staffing mandates would jeopardize patients’ access to care and cause facilities that can’t adequately staff to close. 

Over 80% of nursing homes in the country currently fall short of proposed staffing guidance, according to a September analysis from health policy nonprofit KFF.

Last month, Sens. Kevin Cramer, D-N.D., and Angus King Jr., I-Maine, sent a letter to CMS warning that the mandate would threaten veterans’ access to long-term care. A separate group of 28 senators also sent a letter pushing CMS to abandon the mandate.

The Biden administration is also facing pressure from stakeholders who want the staffing rule to be more robust. A group of 100 House Democrats plans to submit comments to the CMS today asking them to make the staffing requirements stricter, including raising the direct care requirement to 4.2 hours per patient per day, according to the Washington Post.

The comment period for the proposed rule ends today.