Required Staffing Increases, Now?

This is no time for Congress to start penalizing skilled nursing facilities and raising staffing minimums.

Are people in our nation’s capital really that out of touch with reality on the ground? Yes.

Finding quality staff is hard enough in skilled nursing facilities, but then getting reimbursed to pay for them is even harder. So, my senator from Connecticut is a co-sponsor of the Quality Care for Nursing Home Residents Act. Now, who doesn’t want quality care for nursing home residents? I assume everyone, except those who would like to put the sector out of business. 

For your standard 120-bed nursing facility, the bill proposes having three RNs om duty at night, four during the evening hours and about four during the day. Plus, two LPNs and eight CNAs during those night time hours. And if you don’t? A freeze on payments and fines of $10,000 per day. Wonderful.

This is coming at a time when it has been reported that 50% of SNFs in the country have a negative operating margin. On that, however, I have a sneaky feeling it is 50% are losing money after interest, lease payments and depreciation, not a negative EBITDA margin. Otherwise, banks, HUD and landlords would be foreclosing in droves. But I digress.

Instead of coming up with ways to penalize nursing homes, why don’t we thank the RNs, LPNs and CNAs who are trying to do their best in a difficult environment. So, this Thanksgiving, I say thank you for doing a job that most people don’t understand, and that most people would not want to do. And Happy Thanksgiving to all of you as well.  


5 comments on “Required Staffing Increases, Now?

  1. Mr. Monroe, thank you for posting on this important topic. As a consumer advocate, I am happy to see that Congress is considering the possibility of mandatory staffing levels in nursing homes, along with tough enforcement. But I believe that any staffing mandate should include a funding allocation to fulfill any staffing requirement. Not doing so would potentially imperil nursing homes. Staffing is the key to quality care, but trying to conjure some staffing alchemy just won’t work. Congress must make sure that nursing homes have the funding needed to raise nursing home staffing levels. Doing so will dramatically help operators improve resident care and safety. More information about my position can be found on our at

    Thank you again for your insight.

    1. Thank you Brian, and yes, they have to find a way to pay for all the mandates. Unfortunately, it is easier to mandate, which costs nothing, than to find the money to pay for it, and it makes for great political PR. A sorry state of affairs.

      1. I agree Mr. Monroe. Unfunded mandates will not help residents. Unfunded mandates will not help providers. Congress can do the right thing and require the staffing, the tough enforcement, and help providers pay for it. It’s the least we could do for America’s elderly population.

        One thing is for certain. We can all be grateful this Thanksgiving season for the many dedicated caregivers, nurses, administrators, advocates, regulators, and so many others who work diligently to make care safer and better for our families living in nursing homes and other senior care facilities. We owe much to them and their hard work.

        Happy Thanksgiving to them and Happy Thanksgiving to Senior Care Investor. We appreciate y’all very much.



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