Labor union argues nursing home staffing mandates will ease workforce shortage

A worker’s union has intervened in the state of Iowa’s lawsuit to block nursing home staffing mandates, arguing the new requirements will help ease a national shortage of caregivers.

Last year, Iowa joined 19 other states in suing the Biden administration to block the implementation of new, federal staffing requirements at taxpayer-funded nursing homes that collect Medicaid and Medicare for resident care.

The lawsuit, filed in U.S. District Court for the Northern District of Iowa, seeks to overturn the increased staffing requirements that are being phased in by the Centers for Medicare and Medicaid Services. In January, a federal judge rejected the states’ request for an injunction that would have immediately blocked implementation of the new requirements while litigation continues.

In their petition, the 20 states, along with more than a dozen industry associations, argue that the new staffing requirements pose “an existential threat to the nursing home industry as many nursing homes that are already struggling will have no choice but to go out of business,” in part because they can’t find people willing to provide the physically and emotionally difficult work of caregiving in nursing homes.

The Service Employees International Union recently filed a “friend of the court” brief in support of the new staffing requirements, arguing that Iowa and the other states are confusing “a workforce shortage with workers’ reduced demand for understaffed, underpaid positions.”

The union says it is the nation’s largest labor representative of nursing home caregivers, representing more than 150,000 workers in 23 states. In its brief, the union alleges that care facilities’ history of understaffing has not only put residents at risk, it has greatly increased employees’ workload and risk of injury — making the jobs less attractive than they’d otherwise be.

Citing 2023 and 2022 workforce studies commissioned by both CMS and the nonprofit National Consumer Voice for Quality Long-Term Care, the union alleges that “understaffing causes long-term care facilities to churn through nursing staff at extremely high rates because poor working conditions, impossible workloads and a lack of career advancement opportunities are forcing countless workers out of the industry.”

Those factors are deterring people from entering the field and are causing “experienced workers to leave the field in droves,” the union claims. The new staffing requirements, it argues, will decrease worker burnout, improve working conditions and create new opportunities for advancement.

In 2023, the union alleges, Florida lowered its minimum state nurse-aide staffing levels from 2.9 to 2.0 hours per resident, per day. Under that new standard, one nurse aide, Amy Runkle, was responsible for as many as 30 residents in her eight-hour shift at a nursing home, the union says.

The result, Runkle told the union, was that residents were left alone more often, staring at the walls and left to sit in urine and feces. “It’s terrible,” Runkle is quoted as telling the union. “Sometimes they’re not getting their showers. Or eating. They’re getting so lonely and depressed that they just don’t want to eat.”

The new staffing standards, assuming they’re not abandoned by the Trump administration, will eventually require homes to provide 3.48 hours of direct nursing care per resident, per day. The rules also will require the homes to have a registered nurse available 24 hours per day, seven days a week.

Industry officials allege nursing homes will need to hire an additional 27,000 full-time registered nurses and 78,000 full-time certified nurse aides, at a cost of more than $7 billion, to meet the requirements.

The lawsuit brought by Iowa and the other 19 states alleges the new requirements are “not even close to lawful.” That claim appears to be based on the plaintiffs’ argument that CMS lacks the broad authority needed to enact a rule that would “result in at least $43 billion of compliance costs for nursing homes nationwide over the next ten years” without first obtaining congressional approval. The lawsuit likens CMS’ action to pulling an elephant out of a mousehole.

Although the new staffing requirements are to be phased in over two to three years, and include a waiver for homes in rural areas with labor-pool shortages, the lawsuit claims “the reality of a tight labor market requires nursing homes to hire immediately because the available supply of nurses will dwindle as the implementation date approaches.”

Last year, the Iowa Capital Dispatch reported that Iowa nursing homes have the sixth-worst record in the nation for staffing-level violations. Data from CMS show that 14 percent of the state’s 422 nursing facilities were cited for insufficient staffing in fiscal year 2023. That was more than double the national average, which was 5.9 percent.

Only five other states — Hawaii, Michigan, Montana, New Mexico and Oregon — had a worse record of compliance with the sufficient-staffing requirement.

A recent report from the Long-Term Care Community Coalition suggests that 6 in 10 of all U.S. nursing homes would have met the new nurse-staffing standard of 3.48 hours in the fourth quarter of 2023. Iowa homes fell slightly below the national average, with 56.5 percent of them meeting the new standard.

This article first appeared in the Iowa Capital Dispatch.