Nursing home operators in New York and Pennsylvania are stepping into the abyss this month, with no easy way to see just how far they might fall before hitting bottom.
Officials in both states recently decided to move forward with higher staffing mandates that carry financial penalties for providers unable to comply.
If the Centers for Medicare & Medicaid Services is truly still weighing how its federal staffing standard might impact providers, this is the test that could demonstrate whether a clear and present danger exists.
Providers have said new rules could force them to further limit admissions as they continue to struggle with hiring. And fines — $2,000 PER DAY in New York — could strip away money badly needed to recruit and retain workers.
Yes, if CMS wants to know whether those claims are more than hyperbole, they best keep an open line to state survey offices. They’ll be the first to see how dark things get.
One detail that will need close examination (beyond whether potential workers exist to hire to compliant levels) is how any fail-safes built into state laws work.
In New York, the staffing rule includes a waiver application for providers who can prove hiring hardships, but that process was never defined despite months of delays. So, at this time, there appears to be no backup plan. Fines might mount quickly and quite disastrously if they are upheld.
Three-quarters of New York’s 614 nursing homes have struggled to meet the staffing mandate while it was on the books but not being enforced, provider associations have told McKnight’s.
Imagine what will happen if three-quarters of the nation’s nursing homes are unable to comply and face fresh penalties. Where will the money come from? Sure, there are those who believe nursing home profiteers are simply skimming all their proceeds and holding back on staff investments.
But the cost of complying in Pennsylvania is estimated at $200 million, and that’s before factoring in any possible penalties.
Is CMS so callous as to believe providers would willingly pay fines rather than staff up, if labor conditions and recruitment efforts allowed?
Even in New York dollars, it would have to cost less than $2,000 daily to hire enough CNAs to meet requirements. At $20 an hour, one could afford 10 CNAs for 10-hour shifts at that amount.
No, I’m afraid the math simply won’t convert. The worse news is, of course, that any money needed to pay for more staff mandates has to come from somewhere.
So while direct care levels may improve — by way of temporary, unfamiliar agency staff, most likely — other programming and services are almost certain to suffer. Facilities may grow dingy as they wait longer for maintenance, supplies may run low, there could be countless other manifestations as regulators tell operators where to put their money.
When problems emerge, what’s to keep the whole staffing minimum concept from dragging facilities down? What fail-safes will federal officials build in, and how might those keep the most staffing-challenged providers afloat?
As Pennsylvania and New York dive in, CMS might just get the chance it needs to see into the future.
Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
