Woman standing on a stage, speaking
LeadingAge President and CEO Katie Smith Sloan speaks Monday at the 2023 LeadingAge Annual Meeting in Chicago. (Credit: Robb Cohen Photography & Video)

CHICAGO — Even though the staffing mandate proposed by the Centers for Medicare & Medicaid Services directly would apply only to nursing homes, senior living providers as well as providers across the rest of the aging services continuum would be affected because they are “fishing from the same pool” of workers, LeadingAge President and CEO Katie Smith Sloan said Monday.

The bottom line, she said, speaking at the opening session of the LeadingAge Annual Meeting, is that the proposal simply is not viable. “There are just not enough people to hire,” Sloan said.

The CEO said that the proposed standard for nursing homes, as written, would require 90,000 additional nurses and nurse aides at a cost of approximately $7.1 billion annually.

“We know the impact of such mandates have a ripple effect across the whole entire aging services sectors,” she said, adding that “assisted living residents in need of a higher level of care may have to do without, and older adults in independent living seeking intermittent care will not get that support.”

“Shuffling workers among different settings will not work,” Sloan said. “Getting it wrong will undercut equity, access and care across the spectrum of aging services.”

With almost 42,000 comments received and posted from providers and consumers as of Monday morning, including 450 people who submitted comments from the LeadingAge meeting on Sunday — the deadline for comments was midnight Monday — Sloan said in a meeting with McKnight’s Senior Living, McKnight’s Long-Term Care News and McKnight’s Home Care that she never had seen providers so engaged in an issue as this one.

“What this issue is doing is sort of galvanizing our senior living, nursing home community, I think, in a really important way, and really thinking about, ‘What is quality? What does it take to get to quality?” she said.

“In a sense, we’re all fishing from the same pool [for workers]. We’re all looking for employees,” Sloan said. “Every part of the continuum is facing staffing shortages. Sometimes those are personal care aides, nurse aides, nurses, for sure. …For assisted living, you need nursing assistants and personal care aides. So as we tighten the pool and drive more staff to nursing homes to meet whatever the standard may be, you’ve got to get these folks from someplace, unless we figure out a way to broaden the pipeline through immigration or other channels.”

It’ll take CMS “a heck of a long time” to go through all of the comments, she predicted. “They have to read all of them, and that’s going to take months and months and months” and will involve reconciling “very, very, very divergent opinions,” Sloan said, predicting that it will be more than a year before CMS issues a final rule and noting, however, that proposed rules don’t have to be finalized.

Mandate ‘potentially devastating’

Argentum joined a coalition of senior living industry stakeholders — including AMDA–The Society for Post-Acute and Long-Term Care Medicine, the American Seniors Housing Association, the National Center for Assisted Living, LeadingAge, the American Assisted Living Nurses Association, the Association of Jewish Aging Services and Lutheran Services in America — to submit public comments on how the proposed rule would have “potentially devastating impact” on the long-term care industry.

“The vast majority of senior living providers continue to deal with labor shortages and have not returned to pre-pandemic workforce levels,” Argentum Senior Vice President of Public Affairs Maggie Elehwany said in response to the campaign. “Regardless of an assisted living community’s workforce situation, a federal minimum staffing mandate for nursing homes threatens to reduce the available pool of essential caregivers that assisted living and other senior living communities also depend on to serve more than 1 million residents.”

An Argentum report published earlier this year found that the senior living industry will need to attract more than 3 million workers by 2040 to keep pace with a rapidly aging population.

“A federal minimum staffing standard will not create more caregivers. It will simply further exacerbate the current shortage,” Elehwany said, adding that the coalition encouraged CMS to instead focus on efforts to strengthen the long-term care workforce through policies to address training, recruitment and retention. 

NCAL Executive Director LaShuan Bethea echoed comments from American Health Care Association/NCAL President and CEO Mark Parkinson that the staffing mandate won’t create more caregivers.

“It just creates a situation where long-term care facilities, assisted living and other healthcare providers are all competing for a limited pool of caregivers,” Bethea wrote to CMS, adding that senior living communities are at risk of losing staff. “No matter an assisted living community’s workforce situation, a federal minimum staffing mandate for nursing homes threatens to take away essential caregivers on which assisted living communities depend to serve hundreds of thousands of residents.”

The proposal would create a rural struggle for senior living providers for which the main competitor for staffing is nursing homes, she said. In urban areas, long-term care providers are pitted against healthcare providers, competing with each other for the same pool of nurse and direct care staff members, Bethea added.

“Long-term care providers need supportive policies that will strengthen their workforce, not a blanke mandate that doesn’t account for individualized resident needs,” Bethea wrote. This only results in inefficient use of nurses and other caregivers, and threatens access to care for hundreds of thousands of seniors across the care continuum.”

Roberto Muniz, LeadingAge board chair-elect and president and CEO of New Jersey-based Parker Health Group, told the McKnight’s group that aging service organizations provide a diverse number of services and that all will be affected in some way by the mandate. Although his organization promotes aging in place at home “because that’s what people want to do,” eventually those individuals may need to move into a senior living community, and they need qualified people there to be able to care for older adults.

The sooner CMS comes out with a decision, the better, he said.

“As a provider, we’re in limbo,” Muniz said. “We want to know what’s going on, what we should do and what we should be planning to do. It’s a critical issue for us.”