Staff members sitting in chairs and laughing

A federal minimum staffing mandate is on the horizon for nursing homes at the beginning of 2023. Providers and experts wonder just how the proposed mandate might address historic staffing shortages without resources or support.

“Rather than unrealistic, unfunded mandates that will result in more nursing homes closing, policymakers should focus on meaningful solutions to attract more caregivers to the field,” the American Health Care Association said Friday.

Mark J. Warshawsky, a senior fellow at the American Enterprise Institute, former deputy commissioner for Retirement and Disability Policy at the Social Security Administration and former vice-chairman of the 2013 Long-Term Care Commission, agrees with AHCA that the minimum staffing requirement is tantamount to an unfunded mandate.

The federal government’s proposed staffing mandate for nursing homes could cost the industry $10 billion a year because tens of thousands of additional caregivers would need to be hired, according to a report this summer from accounting and consulting firm CliftonLarsonAllen.

Although a minimum staffing ratio for nursing homes sounds like a good policy, money is needed to turn the idea into reality, the Medicare Payment Advisory Commission said at its Sept. 30 meeting.

“MedPAC needs to walk a careful line on recommendations surrounding a staffing minimum, including on pay policies for nursing homes, how to collaborate with Medicaid, and how to account for money already in the system that is being funneled into other areas of the sector,” said Commissioner David Grabowski, PhD, a professor at Harvard Medical School. 

Commissioner Jonathan Jaffery, MD, MS, of the University of Wisconsin School of Medicine and Public Health, added that state staffing policies for nursing homes would also come into play, which could complicate their ability to make quality recommendations to the Centers for Medicare & Medicaid Services and Congress.

“I think we’re probably gonna need some new dollars, ultimately, if these are meaningful staffing standards, and I think that becomes a MedPAC issue if that entails Medicare dollars,” Grabowski added.

Commissioner Kenny Kan, FSA, CPA, CFA, MAAA, of Horizon Blue Cross Blue Shield, said that MedPAC could help CMS develop its standard using payroll-based journal data. MedPAC is not in a position to release any specific recommended staffing minimum, however, he said.

Grabowski agreed, for the most part.

“I think in a vacuum this is a good policy. However, I worry about Scott’s earlier comment, you know, how much dollars are in the system right now to kind of pay for this, and how much new dollars are going to be necessary, how much of that’s going to be Medicare and how much of that’s going to be Medicaid?” Grabowski said.