Nursing home industry scare tactics must not derail long-overdue staffing rules

Thankfully, President Joe Biden made improving nursing home care an administration priority. During his 2022 State of the Union address, he spoke directly about the longstanding, studied, obvious need to substantially improve care to more than 1.3 million nursing home residents. Representing 2.3% of the elderly population, they are our grandparents, our parents, our siblings, our neighbors, and our friends. One day, "they" will be "us".

Residents are entitled to much more care and far better care than they are provided. It is long overdue to prioritize the most fundamental, the most basic, the most impactful changes that are known and understood by everyone to protect and enhance residents' lives: staffing. Of course, every resident, or nearly every resident, will immediately tell you (assuming they don't fear retribution) that staffing levels are grossly inadequate (by the way, who thinks weekends don't require the same staffing levels as weekdays; what's different?).

The current standard, enough staff to meet care needs, is a researched, known failure. Staff turnover is over 60%, pay is exceedingly low, staff are undervalued, and, if that wasn't enough, they are scapegoated for harms caused by owners' prioritizing profits over care. This mostly for-profit industry is made up of investors and equity interests, including so called "related parties" who siphon off cash to make it appear as if the nursing home is losing money.

A recent study titled "Tunneling and Hidden Profits in Health Care" proves this point. Lack of transparency in where the hundreds of billions of taxpayer dollars are actually going is a monumental problem. But, that's for another day, and the nursing home industry would prefer to keep that quiet.

The Centers for Medicare & Medicaid Services (CMS) is responsible for correcting the staffing failure, and, as a direct consequence, its harmful resident outcomes. CMS is looking to finalize its "minimum staffing proposal" in 2024. Its original proposal garnered over 46,000 comments, with the powerful industry, as anticipated, selling horrific consequences (scare tactics) if the proposal is adopted. As expected, aligned politicians (campaign donation beneficiaries) have jumped into the fray, promising to reverse, even if not significantly improved in its final form, CMS's modest staffing proposal.

Recently, the House of Representatives Ways and Means Committee, on a nearly party-line vote, passed H.R. 7513, an industry-inspired bill that would forbid CMS from implementing any staffing requirement, now and forever. I've contacted Rep. Zach Nunn with detailed information about this harmful bill, and requested his position. Iowans should hope that he will not support this bill, and I hope that everyone will encourage their respective representatives to also reject this poison pill that will harm residents. Unfortunately, Gov. Kim Reynolds led 14 of her Republican governor colleagues in a Nov. 1, 2023, letter to Biden with the intent to scuttle CMS's pending rule. Industry's scare tactics formed the basis of this letter.

Notably, more than two decades ago, a study commissioned by CMS found that 4.1 hours of care per resident day, a statistic abbreviated HRPD, was necessary to support quality care, including 0.75 RN hours, 0.55 LPN/LVN hours, and 2.8 CNA hours. Unfortunately, CMS's proposed rule only puts forward two occupation-specific standards: 0.55 RN hours and 2.45 CNA hours, with no requirements for LPNs/LVNs. As to any additional cost (without taking account of significant cost savings by reducing caregiver turnover, saved litigation expense, etc.), the increase would be less than 5% of the over $100 billion that nursing homes receive from Medicare and Medicaid (that is, taxpayers) annually.

In addition to eliminating the nursing home industry's bleeding profits away from staffing, I have another idea that could make a dent in any additional staffing expense. The American Health Care Association (AHCA) is one of the national "nonprofit" groups that represents its member nursing homes. It is a tremendously powerful lobbying organization with two objectives: 1. more government (taxpayer) funding and 2. less government oversight.

Here's a thought. AHCA's 2022 Form 990 tax return notes "Membership Dues" revenue in the amount of $23,964,439. Maybe the AHCA's president, former Kansas governor Mark Parkinson, who lists $2,323,234 in compensation, would be willing to redirect some or all of AHCA's taxpayer-funded membership dues to staffing. Or, maybe our elected officials, with greased palms from the industry, could forbid, instead of allow, taxpayer dollars funding the AHCA.

The AHCA has done everything in its power to either prohibit or restrict CMS's proposed staffing mandate, and we taxpayers paid Parkinson and his overpaid cadre of lobbyists to defeat or lessen the requirements that would protect our seniors from harm.

That's a real head-scratcher!

Dean Lerner retired after 30 years of Iowa public service as an assistant attorney general, chief deputy secretary of state, and deputy director of the Iowa Department of Inspections and Appeals.

This article originally appeared on Des Moines Register: Nursing home industry's scare tactics must not derail staffing rules