WASHINGTON – The Center for Medicare and Medicaid Services (CMS) finalized a rule last month, mandating minimum staffing levels at long-term care (LTC) facilities participating in the Medicare and Medicaid programs, which includes community facilities serving veterans. U.S. Senators Kevin Cramer (R-ND) and Angus King (I-ME), members of the Senate Veterans’ Affairs Committee (SVAC), sent a letter to Secretary Denis McDonough, highlighting the anticipated negative effects of the rule on access to LTC services, especially for the veterans and seniors located in rural areas.
In the letter, the senators request the Department of Veterans Affairs (VA) produce a report on the impact of the CMS rule.
Senators Cramer and King previously introduced a bipartisan bill to require the VA to study the risks the rule poses to elderly veterans. Specifically, the bill requires an assessment of the VA’s ability to continue meeting the LTC needs of veterans at VA and VA-affiliated nursing homes, with a focus on rural areas, if the rule were to be implemented as proposed. The legislation would require the Secretary of Veterans Affairs to submit a report on the VA’s findings to Congress within 60 days of the bill becoming law.
This staffing rule has now been finalized and understanding the potential impact on veterans is even more critical.
“We write to express concerns about the potential harmful impact on veterans resulting from the recently finalized Centers for Medicare and Medicaid Services (CMS) rule, entitled ‘Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting’ (RIN: 0938-AV25),” the senators wrote. “Our healthcare system is grappling with a severe shortage of qualified nurses and caregivers, spurred in part by challenges exacerbated by the COVID-19 pandemic. […] Long-term care facilities in Maine, North Dakota, and across the country have struggled to recover post-pandemic – we cannot simply will a new pipeline of healthcare workers into existence, and without staff to fill the required positions, many facilities face imminent closure. Given the impact CMS’ rule will have on the entire long-term care industry and access to services, we write to request a report from VA to better understand the impact of the Rule on veterans nationwide and in VA facilities.”
“Simply put – we are concerned long-term care facilities, including those serving veterans, may not be able to meet the new staffing requirements,” the senators continued. “Less than one in five nursing facilities nationwide currently meet all staffing requirements prescribed by the Rule. This is particularly concerning given the ongoing struggles of the long-term care industry to adequately hire staff. […] A recent survey indicated that 89% of nursing homes are actively trying to hire Registered Nurses, and 67% cite a lack of interest or qualified candidates as an obstacle towards hiring. An industry analysis estimates nursing facilities will have to hire an additional 102,000 nurses and nurse aides, which is 14,000 higher than CMS’ estimate.”
The senators concluded, “We all want our veterans, older adults, and disabled populations served by long-term care facilities to have adequate staffing to meet their needs. Considering the majority of long-term care facilities nationwide would currently be deemed out of compliance with this rule, and are already struggling to hire and retain staff while on the precipice collectively of needing to spend billions of dollars more per year, we have serious concerns the industry will realistically be able to meet the goals of the Rule, let alone prevent massive widespread closures.”
Senator Cramer has previously raised concerns about the broad impact of this rule on the ability of LTC facilities to continue providing necessary care to aging veterans. In October 2023, Senators Cramer and King wrote a letter to the CMS Administrator, noting the proposed staffing mandate may inadvertently cause the widespread shutdown of rural nursing facilities.
Click here for the letter.