It has been nearly two weeks since CMS released its proposed rule on Minimum Staffing Standards for SNFs, and the chorus of opposition to it continues from SNF stakeholders and also politicians. The Chairman of the House Ways & Means Committee, Republican Congressman Jason Smith, said “this one-size-fits-all deal would ripple through local communities, siphoning staff away from other facilities in desperate need of personnel such as hospitals and hospice facilities, worsening already chronic staff shortages.” Across the aisle, Democrat Senator Jon Tester also commented that “This is just the latest example of Washington bureaucrats displaying how little they understand about the challenges rural America faces.”
More egregiously, the leaked, inconclusive study on the effects of various levels of minimum staffing levels on quality of care did not deter President Biden in an op-ed in USA Today from stating “research shows these staffing levels will save lives, provide residents with a higher quality of life and prevent needless suffering.” That prompted the American Health Care Association to say “It is unfathomable that the Biden Administration is proceeding with this federal staffing mandate proposal. Especially when just days ago, we learned that CMS’ own study found that there is no single staffing level that would guarantee quality care.”
Modern Healthcare also just published a story on the omission of LPNs, licensed practical nurses, from the proposed staffing mandate, despite accounting for as much as 75% of clinical staff at some facilities. Rather, the rule mentioned minimum staffing standards for RNs and for “Nurse Aides.” AHCA also responded to that, saying that the exclusion of LPNs “demonstrates how minimum staffing requirements are inherently flawed and archaic health care policy.” No doubt CMS has received comments on this omission, and LPNs will likely be addressed in the final version, but the gaffe echoes what the critics have been saying. The government mandating a “one size fits all” policy on an entire industry with arbitrary demands based on unsubstantiated evidence makes the “bull in a china shop” seem like a ballerina.
