Nursing home owners are pushing Congress to block a new minimum staffing rule

Opposition to a new nursing home staffing standard has come to a boil with owners seeking to overturn the rule via a Congressional Review Act resolution, a “salted earth” strategy that would prevent the Centers for Medicare and Medicaid Services from ever issuing an amended rule. Given the life-saving implications of implementing a minimum staffing rule—which would require nursing homes to provide a minimum of 3.48 hours of care per resident—here’s a summary of comments EPI submitted in support of the rule, pushing back against unfounded industry claims of a worker shortage that would prevent nursing homes from meeting the new standard.

The nursing home industry has attempted to equate a staffing decline with a worker shortage. But this decline mirrored a decline in occupancy, and, if anything, suggests that there’s a pool of sidelined workers who could be lured back if pay and working conditions improved. This is true in both urban and rural areas.

The industry trade organization issued a report that described the 13.3% decline in nursing home jobs during the pandemic as a “workforce shortage” causing “wage increase pressures and reliance on contracted or agency nursing.” But this was a decline in jobs, not in available workers, as 168,579 residents died and would-be residents opted for alternative care arrangements due to the rapid spread of COVID-19 in facilities. It’s misleading to characterize reduced demand as a workforce shortage when staffing ratios actually improved somewhat during this period.

Tellingly, staffing levels are lower in for-profit nursing homes compared with other ownership types. As we document in our comment, for-profit nursing homes, which dominate the industry, provide fewer nursing hours per resident per day (3.6) than government (4.2) and non-profit facilities (4.3). For-profit facilities also have higher rates of turnover.

While there’s no evidence of a widespread worker shortage, there is a pay shortage. EPI found that nursing homes pay registered nurses and aides less than other health care providers.

Many aides earn poverty-level wages despite difficult working conditions. It’s difficult to explain a national shortage of workers in an occupation that doesn’t require highly specialized skills or training, unless the supposed “shortage” stems from the fact that employers aren’t offering pay commensurate with the demands of the job.

Increased workloads and unsafe conditions also induced many registered nurses to quit or retire early during the pandemic and contributed to the first decline in nursing school enrollment in 20 years. Staffing standards would help nursing homes attract and retain nurses by improving working conditions.

Our analysis suggests that short-term workforce shortages are unlikely, and long-term shortages can be averted. Rather than indicating a nationwide shortage of trained staff, the recent downturn in employment suggests that there’s a pool of experienced workers who could return to nursing homes if pay and working conditions improved.