Press Releases

Hickenlooper, Colleagues Push Biden Administration on Rural Nursing Home Staffing Shortages

Jan 23, 2023

Bipartisan group of Senators call on CMS Administrator Brooks-LaSure to consider rural health care workforce needs

WASHINGTON- U.S. Senator John Hickenlooper and a group of his colleagues sent a letter to Center for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure expressing concern about CMS’ plan to issue blanket staffing mandates for nursing homes.

The senators emphasized that workforce mandates would increase financial pressure on rural nursing homes that are already facing significant workplace shortages. The group urged CMS to instead provide tailored financial resources to struggling nursing homes and incentives to help recruit caregivers to rural facilities.

“We fear a one-size-fits-all staffing mandate would undermine access to care for patients, particularly in rural communities,” wrote Hickenlooper and his colleagues. “Instead, we urge you to work with Congress and rural stakeholders on tailored solutions that address the severe workforce challenges in our states’ underserved areas.”

“Going forward, we recognize CMS as a crucial partner in identifying, mitigating, and preventing future health and safety problems in nursing homes,” the letter continues. “The best way to accomplish this goal is working with Congress and stakeholders to ensure any future actions do not further exacerbate the serious challenges already facing facilities in rural America.”

Since the start of the pandemic, nursing homes in small towns across Colorado and the country have battled staffing shortages and increased costs leading to nationwide closures. These closures have made it difficult for seniors to access care during a critical time of need. 

One-size-fits all federal staffing mandates would burden underserved nursing homes that are already struggling to keep their doors open, putting aging communities at further risk.

“Colorado’s long-term care providers appreciate Senator Hickenlooper’s leadership in searching for solutions that are attainable,” said Doug Farmer, President and CEO of the Colorado Health Care Association. “Providers, particularly in rural communities, are struggling with workforce challenges exacerbated by the pandemic and blanket staffing mandates will only make the problem worse. We look forward to our continued partnership with Senator Hickenlooper in finding ways to solve our health care workforce challenges.”

Full text of the letter can be found HERE and below: 

Dear Administrator Brooks-LaSure,

We write to express our concerns regarding the Centers for Medicare and Medicaid Services’ (CMS) intent to issue staffing mandates for nursing homes.

Like you, we understand the importance of ensuring beneficiaries of federal health care programs have access to safe and high-quality nursing care. However, we fear a one-size-fits-all staffing mandate would undermine access to care for patients, particularly in rural communities. Instead, we urge you to work with Congress and rural stakeholders on tailored solutions that address the severe workforce challenges in our states’ underserved areas.

While we support evidence-based policies to improve beneficiary care in nursing homes, staffing mandates are not the only solution. First, sweeping staffing mandates do not account for individual facilities’ operational capabilities and local workforce conditions. For example, minimum staffing standards that establish strict staff-to-patient ratios and/or minimum hours per resident day requirements may not reflect optimal staffing levels given differences in patients’ needs and underlying conditions, as well as the skills of the personnel at-hand.[1]

Additionally, blanket staffing standards may not provide enough flexibility to nursing homes in light of well-known and long-standing obstacles to the recruitment and retention of direct care workers, especially in rural and underserved areas.[2] This challenge is exacerbated by the fact that the health care sector is projected to have a shortage of nurses (10 to 20% based on a spring 2022 estimate) in the coming years.[3]

Finally, meeting staffing mandates will place nursing homes in financial jeopardy. This could lead to the shuttering of facilities, especially in rural communities. There is no question such a scenario would only amount to a counterproductive regulatory environment that leaves vulnerable patients and their families with far less access to care.

Going forward, we recognize CMS as a crucial partner in identifying, mitigating, and preventing future health and safety problems in nursing homes. We stand ready to work with your agency on proposals to improve long-term care for patients. The best way to accomplish this goal is working with Congress and stakeholders to ensure any future actions do not further exacerbate the serious challenges already facing facilities in rural America.

Sincerely,

1 “Comment on CMS-2022-0069-0002,” Regulations.gov, accessed January 19, 2023, https://www.regulations.gov/comment/CMS-2022-0069– 5028

2 Bhatnagar, Sabah, et al., “The Impact of COVID-19 on the Rural Health Care Landscape: Challenges and Opportunities,” Bipartisan Policy Center, May 2022, https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2022/05/BPC-Medicare-Rural-EmerHsp_R02.pdf

3  Berlin, Gretche, et al., “Assessing the Lingering Impact of COVID-19 on the Nursing Workforce,” McKinsey & Company, May 11, 2022, https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursingworkforce

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