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Bob Russell, center, makes a point as LaShuan Bethea, left, and Dan Farmer look on at a session during the AHCA/NCAL Congressional Briefing. (Photo by Kim Marselas)

WASHINGTON, DC — A large-scale overhaul of assisted living oversight isn’t likely to find much support in the current legislative environment, but experts here Monday warned that providers still must brace for the impact of increased regulation.

Speaking on the first day of the American Health Care Association/National Center for Assisted Living Congressional Briefing, NCAL Executive Director LaShuan Bethea warned her members that the nursing home staffing rule proposed by the Centers for Medicare & Medicaid Services would have significant implications for them, too.

“The bottom line is that, while AL has seen some recovery in terms of its workforce and a significant recovery in terms of its occupancy, our workforce is completely fragile,” Bethea said. “Something like this minimum staffing rule is the biggest threat to access to care in our communities. …When you implement a rule [that] looks to pull workers from all settings into nursing homes in a one-size-fits all approach, then you are doing nothing more than creating access issues across the country.”

More than 650 assisted living and skilled nursing providers — a record number that AHCA/NCAL leaders attributed to the staffing rule’s potential effects — are gathered here this week to learn about current considerations in Congress and meet with leaders from their districts. Bethea urged assisted living providers to be a part of vocal part of the staffing rule protests.

She warned that the rule, if allowed to go forward with nursing home hiring requirements kicking in by 2025, would harken back to the early days of COVID-19. During that time, assisted living providers found themselves hard-pressed to find job applicants and were paying previously unheard-of rates to land direct care staff.

Inflated labor rates, Bethea said, potentially would run the risk of “pricing people out of care,” especially on the heels of record inflation.

“This is not just an issue on minimum staffing that impacts skilled nursing facilities only,” added Dana Ritchie, AHCA/NCAL’s associate vice president for member services and government relations. “This is the healthcare continuum. …That’s a critical point.”

Of course, assisted living providers have been under more scrutiny themselves in recent months, and many providers are concerned they could soon face more federal oversight.

Bethea noted at least two recent congressional hearings in which assisted living got first or second billing, including a US Senate Special Committee on Aging hearing that led to a request for a fresh review by the Government Accountability Office of assisted living industry pricing and transparency.

“We have enjoyed an environment where assisted living has not been specifically mentioned in legislation, or for that matter, in federal regulations, up until recently,” Bethea noted. 

She added that the review actually could be good news for the sector, because it could highlight differences in how states opt to fund assisted living through Medicaid waivers and underscore how little of home- and community-based funding actually makes it to assisted living providers.

And asked whether operators soon would find themselves regulated in the same way or with the same intensity as nursing homes, two lobbyists predicted that Congress would have little appetite for such major reform.

“When you have those types of moments, like the hearings, that can bring a lot of skepticism to an industry,” said Dan Farmer, principal at the BGR Group. “I have a hard time believing that in the charged environment we’re in, where legislating even on bipartisan issues is so hard, that coming up with a comprehensive new framework of regulation for the assisted  living industry is something that is going to happen in the near term.”

Bob Russell, a partner at the Simmons & Russell Group, noted that even on the staffing mandate, lobbyists and providers are having success using tales of reduced access to reach additional lawmakers.

“Once we get into this, who’s going to be competing for those resources?” Russell said. “It’s just going to drive the price of that commodity up, up and up. It’s a thoughtful issue that is being dealt with in an unthoughtful way. It is designed to ensure better care, and it will increase less care.” 

Bethea also encouraged providers to try to get the “horse” back before the cart by asking their members in Congress to advocate for workforce legislation, even legislation that applies only to skilled nursing providers. The bills it is advocating for include the Train More Nurses Act, the Care for Our Seniors Act, the Safeguarding Elderly Needs through Innovation and Occupational Resources, the Healthcare Workforce Resilience Act, and Ensuring Seniors’ Access to Quality Care Act, and the Building America’s Health Care Workforce Act.

The Congressional Briefing continues Tuesday with an update from Rep. Katherine Clark (D-MA) and more from Bethea, AHCA/NCAL Senior Vice President Clif Porter and more.

For additional coverage of the event, see sister media brand McKnight’s Long-Term Care News, which focuses on skilled nursing.