Proposed new rules for nursing homes have sparked warnings and fear; rural residents are the most vulnerable

National Cancer Institute photo, Unsplash

The Centers for Medicare and Medicaid's new staffing mandates were met with alarm and fear, with descriptions including 'a disaster,' 'insanity', and 'catastrophic.' The Biden Administration's "proposed federal staffing mandate will be impossible for the nation's nursing homes to meet, limiting access to care for our seniors," reports The American Health Care Association. "CMS released the one-size-fits-all mandate earlier this year, despite its own study finding no level of staffing guarantees quality of care."

The angry reaction and warnings are particularly problematic for rural Americans. "As nursing home closures continue across the country, 'nursing home deserts' are expanding, and the proposed federal staffing mandate is expected to exacerbate the problem," reports Amy Stulick of Skilled Nursing News. "This is despite attempts to make the potential policy change easier for providers in rural markets, which are especially vulnerable to access issues. Operators in these areas point to the 24-hour RN requirement as being especially devastating."

Finding nurses, let alone 24-hour nurses, is impossible in certain areas. Nate Schema, CEO of the Evangelical Lutheran Good Samaritan Society, "says the organization's facilities located in 'deep rural communities' will struggle the most with the 24-hour RN rule," Stulick writes. "In communities like Bloomfield, Nebraska, pop. 1,000, or Miller, South Dakota, pop. 1, 300, Schema isn't sure where Good Samaritan will find even six RNs; the Miller facility hasn't had a night nurse for upward of three years."

"The ability to have a nursing home open in a small town is getting more difficult because of the disparity between Medicaid reimbursement and overall costs, says Accura HealthCare CEO Ted LeNeave," Stulick reports. "Accura operates 34 communities across Iowa, Minnesota, Nebraska and South Dakota." LeNeave told Stulick: "The provider relief fund helped to mask how bad those problems were. Once that cash dried up, buildings started closing. This concept of a nursing home desert is an area where residents need nursing home care, but there's no access to them. Then they have to drive 45 minutes to an hour to be somewhere else."

Michael Beal, CEO of Care Initiatives, told Stulick, "It doesn't matter if it's 5, 10 or 15 years, if there's no additional reimbursement, it's just a timing question on when that will affect [rural operators]; it just kicks the can down the road." Stulick reports: "Beal added that the suggested rule of 'adding that an arbitrary number of staff hours per resident day without a reimbursement mechanism, and the ability to actually hire staff puts rural operators in an 'untenable situation.'"