Rick Abrams on Federal Standards for Nursing Home Staffing

Zac Schultz:
Earlier this week, Vice President Kamala Harris was in La Crosse to introduce new federal standards for nursing homes in long-term care facilities. Once finalized, the new rules would implement a minimum number of hours staff would have to be around patients and require a registered nurse on-site at all times. It would also require 80% of Medicaid reimbursement go towards employee wages. Vice President Harris noted many of the workers in this industry have been traditionally underpaid, a factor that leads to staffing shortages.

Kamala Harris:
One of the character traits of real leaders is to have some level of compassion and concern about the suffering of other people and then want to do something about that to improve their condition. That’s the work of these workers that we’re talking about right now. And we as a society should value that.

Zac Schultz:
Current law only says facilities need to have “sufficient staffing.” While many nursing homes already meet these new standards, the government says a majority of the country’s 15,000 nursing homes would need to add staff in order to come into compliance. To give us the Wisconsin perspective, we are joined by Rick Abrams, the executive director of the Wisconsin Healthcare Association and the Wisconsin Center for Assisted Living. Thanks for your time today.

Rick Abrams:
Zac, it’s a pleasure to be here.

Zac Schultz:
Give me a snapshot of what the long-term care industry is in Wisconsin. Are there enough beds and workers to provide for a generation of aging baby boomers?

Rick Abrams:
You know, Zac, at this point, there are enough beds. We’ve got approximately 26,000 nursing home beds in the state. Our average statewide occupancy is about 70%, so you’ve got capacity, but the challenge is dedicated workers. The labor shortage was always a problem in Wisconsin. Certainly was exacerbated with the pandemic. And from our perspective, and I’m sure we’ll talk more about it, a cookie cutter black and white staffing minimum just is not the right approach.

Zac Schultz:
So, yeah, let’s talk about what is your reaction to the new regulations? Are there any particular that seem more onerous or difficult for nursing homes and long-term care facilities to actually meet?

Rick Abrams:
You know, Zac, two things. First, even though we may disagree with the approach, there’s no question that everyone is well-intentioned. Whether you’re a federal policymaker like our vice president is, state policymaker, and certainly the folks in the sector, but when you look at the requirements of the minimum staffing mandate, the most difficult to meet is going to be the requirement of having a registered nurse, an RN, if you will, on-site 24 hours a day, seven days a week. That’s going to be difficult, if not impossible in some cases to meet simply because there are not enough RNs. But equally concerning to us is that that 24/7 requirement, if you will, applies whether you’re a 40-bed nursing facility in rural Wisconsin or a 500-bed nursing facility in Bronx, New York. That just doesn’t make sense to us. We think there’s a better approach.

Zac Schultz:
So I want to read a statement we received from Kim Marheine, the state’s ombudsman on long-term care. She says many ask whether the time is right for these changes, given current staffing stressors facing the long-term care industry. Though there may never be a best time for these changes, consumer needs and expectations demand the time is now. What’s your response to that statement?

Rick Abrams:
Well, first, I have great respect for Kim. In fact, I got my start in long-term care as a long-term care ombudsman. But, you know, Zac, in the beginning, in your introduction, you talked about the current standard, and the current standard is sufficiency. Not only in numbers, but also in expertise, and we think that that is the right approach, because every nursing home, not only in the state of Wisconsin, but literally every nursing home in this country has a different patient mix. And the facility is duty-bound to staff to that patient mix. And we think that that’s the right approach.

Zac Schultz:
So will this result in nursing homes closing down? Will they just not be able to accept people? What’s the bigger implication, especially in rural Wisconsin?

Rick Abrams:
You know, I think there’s three implications, two of which you’ve addressed. I do believe that, especially in rural areas for our small community-based facilities, they may need to — they may need to close if they cannot meet these standards, because not meeting the standards then carries with it substantial penalties, and a facility can’t sustain that. But, you know, if a facility finds that after a good faith effort, they just cannot staff to the requirement, they’re going to then reduce the number of beds that are occupied. And when that happens, especially in rural areas, access is challenged, and nobody wants that to happen. But you know, Zac, the third thing, and this is purely from my perspective, is that if a facility cannot achieve the 3.48 hours per resident day, if they’re not in a position to reduce the number of occupied beds, what that does is it puts more pressure on the staff that is there and the biggest concern that I have with that is that that is going to hasten burn-out and that is going to hasten the exodus of these good and dedicated people from our sector, and nobody can afford that. So really, you know, your question was excellent. And for one, two, or all three of these reasons, we just don’t think a black and white cookie cutter, however you want to describe it, minimum staffing standard is the right approach.

Zac Schultz:
All right. Rick Abrams, thanks for your time today.

Rick Abrams:
It’s my pleasure. Take care.