A cadre of lobbyists fight nursing home staffing rules at the federal level

Thankfully, the president of the United States made improving nursing home care an Administration priority. During last year's State of the Union address, President Joe Biden spoke directly about the long-standing, studied, obvious need to substantially improve care to more than1.3 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 change that is 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 and 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 proves this point: Tunneling and Hidden Profits in Health Care, Ashvin Gandhi, Andrew Olenski, UCLA & NBER Lehigh University, March 4. Lack of transparency in where the hundreds of billions of taxpayer dollars are actually going is a monumental problem. But, that's an expose' 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 (Republicans and campaign donors) have jumped into the fray, promising to reverse the modest CMS staffing proposal.

Recently, the U.S. 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 hope everyone will encourage their representatives to also reject this poison pill that will harm residents. Unfortunately, Gov. Kim Reynolds led 14 of Republican governors sent a letter to President Biden in November with the intent to scuttle the pending CMS rules.

Notably, more than two decades ago, a study commissioned by CMS found that 4.1 hours of care per resident day (HPRD) was necessary to support quality care, including 0.75 RN hours, 0.55 LPN/LVN hours, and 2.8 CNA hours. Unfortunately, the CMS proposed rules only set 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 savings by reducing caregiver turnover, litigation expenses, etc.), the increase would be less than 5 percent of the over $100 billion that nursing homes receive from Medicare and Medicaid annually.

In addition to eliminating the nursing home industry's practice of 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 "not-for- profit" 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 president and CEO, Ex-Kansas Gov. 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' proposed staffing mandate, and taxpayers paid Mr. Parkinson and his cadre of lobbyists to defeat or reduce requirements that would protect our seniors from harm.

That's a real head-scratcher!

Dean Lerner is a former Iowa assistant attorney general, former chief deputy secretary of state, and former director of the Iowa Department of Inspections and Appeals.