According to 2021 data, more than 55.8 million adults ages 65 and older live in the U.S., accounting for about 16.8% of the nation's population. If we are lucky we will one day join that demographic.

We are living longer than ever before. That also means the need for caregivers and places for elderly citizens to live will continue to rise. However, a proposed mandate from the Centers for Medicare & Medicaid Services (CMS) is threatening rural long-term care facilities and their very existence.

On Sept. 6, CMS released the proposed rule, Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting (CMS-2023-0144-0001). That’s a mouthful, and reading through the proposal can be very confusing. We talked to an “expert” in the field to find out what it all means, and the impact that the rule - if passed - could have on our local long-term care homes.

Tim Groshans is a registered nurse who currently serves as a long-term care consultant serving several nursing homes in central Nebraska. One of those facilities is Callaway Good Life. “We’ve known that there was a staffing mandate that would be coming out for years,” said Groshans.

He explained that in the world of long-term care facilities are operated based on a figure of “per resident day” (PRD) or “per patient day” (PPD). “We initially were concerned with how high the total staff requirement would go. We had that somewhat projected, but when this finally came out it was far worse, but not from the perspective of totals,” said Groshans.

The majority of the facilities he works with now run at a higher rate than the proposed 3.00 PRD - meaning each resident receives, on average, 3 hours of patient care per day. “The thing that completely caught us off

cont. PAGE 3 - Nursing Homes guard, and the reason why this mandate is so flawed, is the inability to recognize how long-term care functions at the very basic level,” said Groshans.

He explained that long-term care functions on what is called team nursing, which means a facility needs an acceptable number of registered nurses for mostly administrative- type duties; quality LPNs (licensed practical nurses) that do charge functions such as medication passes and treatments; and as many nurse aides and med aides as the facility can handle.

“The majority of long-term care at the bedside level is not RNs or LPNs, it’s nurse aides and med aides. They came down with a 2.45 (PRD) for nurse aides and/or med aides. We run higher than that now,” added Groshans.

He said the big flaw comes at the proposed RN level. “It’s a major flaw - .55 hours of registered nurse coverage per day, minimum, or 24/7. You will have to have an RN in your building 24 hours a day, seven days a week. In today’s labor market, number one you can’t hire to it, and number two, it’s not a quality staffing pattern.

“RNs that start out as med aides and nurse aides go to school for a reason. And when they pay money to go to school and get that degree, they don’t come back expecting to work at a nurse aide or med aide level,” he added.

The second major flaw in the staffing proposal is that no recommendations at all have been placed on LPNs. “They are a major part of what we do,” said Groshans.

Groshans currently works with three major facilities. “If the mandate goes through and I am forced to compete for RNs, there is one major entity that I will go after. Hospitals. They have the RNs,” Groshans said. “So now long-term care is aggressively seeking RNs that aren’t needed at a bedside level, taking them away from critical access hospital where they are majorly needed at a bedside level, and that’s better quality for both?”

CMS is saying they will allow facilities to phase in the new guidelines over a three to five-year period. “What they are saying is, if we don’t meet the staffing requirement, the surveyors could give us a deficiency and refuse to pay for new Medicare and Medicaid residents. So not only are they going to require us to have a higher expense level that is not in line, if we can’t get there they just aren’t going to pay for the service. I don’t know how you could ever come up with something that’s more backward.”

The definite reality of the proposed requirements would be facilities no longer able to take Medicare and Medicaid patients. “Then where are they going to go? They’ll stay in the hospital. It’s pretty backward,” added Callaway Good Life Administrator Todd Sutherland.

The proposal is currently in a 90-day hearing period, during which time people can write to CMS voicing their opposition to the mandate. Groshans and Sutherland encourage everyone reading this to reach out to Sen. Deb Fischer by email at fischer.senate.gov, or call her Washington, D.C. office at (202) 224-6551. You may also make your voice heard by CMS by filling out the form at https://www.votervoice.net/AHCA/Campaigns/103471/ Respond We will continue to follow this extremely important story and provide our readers with information pertaining to the proposed mandate and what you can do. “Sen. Fischer’s office needs to be very clearly aware of how bad this policy is,” said Groshans.

Sutherland added, “It’s the closure of most rural nursing homes.”