Unfunded nursing home mandates in “Build Back Better Act” will worsen historic staffing crisis

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes and long term care facilities across the country that provide care to approximately five million people each year, today said that two provisions in the Build Back Better Act (H.R. 5376) will have a devastating impact on nursing homes and could force thousands more facilities to further limit admissions or possibly close their doors.

The provisions, one that would require nursing homes to have a registered nurse (RN) on-staff 24 hours a day and another that would require the U.S. Department of Health and Human Services (HHS) to conduct a study on minimum staffing ratios and implement the regulations within one year, are unfunded mandates that conservatively, would cost the nursing homes industry billions of dollars a year and require hiring more than 150,000 new caregivers.

“We strongly support having a RN on staff in nursing homes 24 hours a day, as we originally proposed in our reform agenda earlier this year. However, current data shows that the nursing homes are facing the worst job loss among all health care providers. We’ve lost 221,000 jobs since the beginning of the pandemic, and recovery is a long way away. Nursing home providers are doing all they can to attract and retain new workers, but the applicants simply aren’t there. The provisions in this bill do nothing to help us strengthen our workforce and will only force thousands of nursing homes to further limit the number of residents they can serve,” said AHCA/NCAL President and CEO Mark Parkinson.

AHCA/NCAL estimates that if the HHS study found that nursing homes need to increase clinical and direct care staff by 25 percent, it would require hiring more than 150,000 RNs, licensed practical nurses (LPNs) and certified nursing assistants (CNAs), costing $10.7 billion per year.

Current requirements mandate that nursing homes have a RN on staff eight hours a day. Under the proposed mandate in the legislation, AHCA/NCAL estimates it would require hiring 21,000 more nurses, costing $2.5 billion a year.

Phil Fogg, President and CEO of Marquis Companies, who operates more than 20 long term care facilities in California, Nevada and Oregon, said if Congress enacts these provisions without the necessary resources and recruitment programs, it could have a devastating impact on nursing homes and the residents they serve across the country.

“The workforce and economic crisis long term care providers are already experiencing is unprecedented. Lack of qualified workers is forcing providers to limit their admissions and, in some cases, close their doors permanently. Providers simply cannot attract more caregivers to our profession and meet the requirements of these mandates without financial support from Congress,” said Fogg, who is also the chair of the AHCA Board of Governors.

“We all share a common goal and that is to strengthen our workforce and provide the best possible care for our residents. But these unfunded mandates could further exacerbate the challenges we face and ultimately limit access to care for millions. We are eager to work hand-in-hand with lawmakers to find meaningful solutions that will ensure seniors continue to receive the highest quality care and caregivers have access to good-paying, rewarding jobs,” said Len Russ, operator and administrator of Bayberry Care Center in New Rochelle, NY.