The truth about the Administration's final minimum staffing rule

During the 2024 AHCA/NCAL Congressional Briefing, I had the opportunity to join association and industry peers during a press conference focused on federal regulators' minimum staffing rule for nursing homes, which was finalized and issued in May. I was honored to stand alongside Mark Parkinson, president & CEO of AHCA/NCAL, Katie Smith Sloan, president & CEO of LeadingAge, Alexa McKinley Abel, J.D., director of government affairs and policy of the National Rural Health Association, Melissa Jackson, past president and current liaison officer for the National Association of State Veterans Homes, Patricia Horn, co-owner of Cedar Hill Continuing Care Community, and Clif Porter, senior vice president of government relations for AHCA/NCAL. Together, we shared why the rule is unrealistic due to workforce shortages, why it threatens access to care for seniors and what solutions would be more effective in meeting the Administration's intent behind the rule. I've published my full remarks from the press conference below. Thank you, AHCA/NCAL for inviting me to share the perspective of the Good Samaritan Society . Read insights from my co-presenters in this McKnight's Long-Term Care News reporting by Kimberly Marselas

My name is Nathan Schema, and I am the president and CEO of the Good Samaritan Society. We are the nation’s largest non-profit provider of skilled nursing services with 139 nursing homes. We also provide assisted living, memory care, independent senior housing and home care services. We are part of Sanford Health, the largest rural health system in the nation. Together, we provide the full range of health services to our communities.

70 percent of the long-term care residents we serve live in rural communities, primarily in the Upper Midwest. These are communities of 500 to 5,000 people, where our residents are retired teachers, farmers, pastors, business owners and veterans. As a rural health system, we wake up every day asking ourselves how we can solve the unique challenges of rural health care delivery so we can protect access to care.

I appreciate the opportunity to share with you today what a federal staffing standard will mean for our nursing home residents and their families.?

Joining me in Washington DC this week is Laura Salonek. Laura has served as the administrator of the Good Samaritan Society’s skilled nursing location in Howard Lake, Minnesota for 15 years. Howard Lake is a rural community with a population of 2,000 located an hour west of Minneapolis. In this community, we provide care to Howard Lake locals, and also serve as a lifeline to hospitals in Minneapolis that struggle discharging patients to nursing homes in the metro area.

Through a team-based approach, Laura and her staff provide excellent care to 32 residents. They are a 5-star location. They also have a strong and vibrant workplace culture, with a turnover rate below the industry average at 22 percent.

It’s rare for Laura to have staff openings, but when she does, RN and CNA positions are the most difficult to fill. On average, it takes Laura a year to fill these positions. She recently had a nurse leave because her husband got a new job out of town. The job was posted for one year before Laura could fill it. Despite heavy recruitment efforts and offering a sign-on bonus and competitive wage, she had very few applicants and even fewer that were qualified for the role.

Under the Administration’s new staffing requirements, Laura will need to hire at least three more caregivers. When it takes a year to fill one job opening, this puts Laura and her 5-star location in a difficult position.

If they cannot hire staff to meet the increased requirements, they will need to reduce the number of residents they serve. Howard Lake locals will be forced to move away to receive care because we’re the only nursing home in town. Patients from Minneapolis will have a harder time accessing nursing home care and getting out of the hospital.

It’s dangerous and unnecessary to make it harder for rural seniors to access care in communities like Howard Lake when we already provide exceptional quality care today, with a team that is dedicated to our mission and treats residents like members of their own family.

Unfortunately, access to care has already become more difficult because of the historic hiring challenges we’ve had since the pandemic. The staffing rule will only make matters worse. Across our skilled nursing facilities, 1,500 positions remain unfilled – that’s a shortage of nearly 20 percent of our workforce, or an average of 11 openings per location.

We’re addressing the issue from all sides – we’ve invested over $75 million in pay raises, created positions that offer more flexibility, launched new programs to support hiring and retention, and offered bonuses, incentives and scholarships.

These efforts are making a difference. In a recent employee satisfaction survey, three out of four employees shared their feedback, and since the pandemic, we’ve seen steady and significant growth in the number of employees who rate our work culture in the highest category.

Despite this, workforce remains a very real concern, and in combination with chronic Medicaid underfunding, it’s the primary reason why we’ve had to permanently close 14 nursing homes since 2020. Nearly all were in communities of less than 3,000 people. Closure is a last resort, and it is devastating and disruptive to our seniors and their families, especially in rural areas where the next closest nursing home can be an hour-drive away.

Enforcing a one-size-fits-all staffing requirement will create an access crisis for our rural communities where the availability of qualified caregivers is already limited.

For perspective:

·???????? Less than five percent of our locations meet the rule’s requirement to have an RN on-site 24 hours a day.??

·???????? To meet the standards, we would need to hire over 100 RNs and over 300 CNAs.

It’s impossible to imagine how a skilled nursing facility in a town of 1,500 people will be able to find 24-7 coverage for an RN, when they already have open RN positions they can’t fill today.

The mandate will not magically create more applicants or RN degrees. It will not improve quality. It will only reduce access and remove seniors from their loved ones and the lives they know.

Quality is not just a numbers game. We use a team-based approach to care for our residents and make staffing decisions based on their unique needs.

Consider the community of Canistota, South Dakota, population 600 where we serve 50 residents and have a licensed behavioral health program. Due to the high demand for these services, we are always at full capacity. We take pride in our robust life enrichment program that keeps residents engaged in meaningful activity – which is critical for individuals with behavioral health needs.

Through the Administration’s narrowly focused staffing rules, the critical role of our activities staff is disregarded.

In this rural area, it is extremely challenging to find qualified candidates for caregiver positions, and Canistota will be required to hire 2 more RNs and 3 more CNAs to meet the requirements. This town of 600 is considered “urban” by federal regulators, and like every other facility in the states of South Dakota, Nebraska and Wyoming, it is not eligible for an exemption.

The residents and families we serve will ultimately pay the price for the impossible standards being set.

Is our 5-star facility in Howard Lake, and our behavioral health program in Canistota the types of nursing homes the Administration wants to put out of reach for our nation’s seniors?

The residents and families we serve, and the caregivers who have dedicated their life to this work, are worth fighting for.

I am urging the Administration to refocus its efforts and energy on solutions that will build back the caregiving workforce and protect access to high quality care for our seniors close to home.

Thank you.