A new analysis from one of the nation’s leading health policy research organizations confirms what the state’s long-term care providers have warned: The state’s nursing homes do not have enough staff to comply with the new Biden administration staffing.
According to KFF analysis released last week, only 26 percent of New Hampshire long-term care facilities, 19 out of 73, could comply with a new rule from the Centers for Medicare and Medicaid Services with current staffing . KFF noted that CMS has estimated that closing the staffing gap will be costly for the nation’s nursing homes: $43 billion in the 10 years after the final rule takes effect.
“It’s just impossible, especially in a rural state like New Hampshire,” said Brendan Williams, president and CEO of the New Hampshire Health Care Association. “You just can’t find those people. You can’t find licensed nursing assistants. You can’t find the registered nurses.”
Patients and their families have told CMS they support the rule as a means to improve patient care. A Milford clergyman was among those who submitted nearly 50,000 comments on the rule after it was first proposed in 2023.
“I have witnessed firsthand the difficult conditions in several nursing homes due to lack of staff,” wrote the Rev. Hays Junkin. “This is tragic; Our seniors and their caregivers deserve a safe, well-staffed residence. “I urge you to push for adequate staffing and ignore opposition from the nursing home industry.”
The Centers for Medicare & Medicaid Services’ current staffing rule requires 24-hour clinical staffing and sets standards for patient care, but leaves facilities discretion over specific staffing details. For example, in most cases, a facility must employ a registered nurse for at least eight consecutive hours a day, 7 days a week.
The new rule, which will go into effect in 2026 for urban facilities and 2027 in rural areas, requires a nurse to be on call 24 hours a day, seven days a week. Each patient must receive 33 minutes of care per day from a registered nurse and 147 minutes of care from a nursing assistant. Facilities could apply for “hardship” waivers if they met several requirements.
KFF’s analysis found that New Hampshire is closer to meeting the registered nursing staffing requirement, with 79 percent of facilities able to provide each patient with 33 minutes of care from a registered nurse each day. Only 30 percent of facilities meet the requirements for nursing assistants, it found.
Williams said CMS’s new “one-size-fits-all” staffing rule ignores New Hampshire’s “job crisis hellscape” and the shortage of affordable housing and child care that makes it difficult to recruit new workers. Added to that, the state’s unemployment rate is low and Medicaid reimbursement rates don’t cover the cost of providing care, she said.
Nursing facilities across the state are already limiting admissions because they don’t have the staff to fill all of their beds. Williams said complying with the new staffing rule will leave long-term care facilities without good options. The state and counties would have to raise taxes. Private establishments would have to charge more. Or the facility will close.
Critics of the rule include U.S. Rep. Chris Pappas, who joined other members of Congress in raising concerns to CMS twice in 2023, before the rule was finalized, about the impact on nursing facilities.
“We believe the proposed rule is overly burdensome and will result in additional closures and reduced access to care,” he wrote. He continued, “We recognize CMS as a crucial partner in identifying, mitigating and preventing future health and safety issues in nursing homes. “We stand ready to work with your agency on proposals to improve long-term care for patients.”
In an email last week, Pappas said he continues to have concerns and is disappointed that CMS has not incorporated the feedback he relayed to him from concerned New Hampshire health care providers.
“I have the utmost faith and trust in New Hampshire’s healthcare workers who do incredible work keeping our communities healthy, and I remain committed to supporting access to high-quality care for people living in nursing homes.” Pappas said.
He added: “Without additional support from Congress and CMS for our long-term care facilities and seniors, these new regulations have the potential to seriously disrupt a long-term care system already under tremendous strain.” . “We must provide long-term care facilities with the resources and funding to stay open, recruit and retain a strong workforce, and provide residents with the best care possible.”
Gov. Chris Sununu also expressed concern and joined 14 other governors in 2023 in calling on the Biden administration to drop the rule.
Sens. Jeanne Shaheen and Maggie Hassan were two of three Democrats who joined nearly 20 Republicans and independents that year to urge CMS to pause and rethink the rule.
A spokesperson for Hassan’s office said she and Shaheen are evaluating changes to the rule that CMS has made since it first introduced it.
These include a phased approach to give facilities more time to complete initial staffing assessments; a new exemption for facilities that would not be able to meet the registered nurse requirement; and clarification that physician assistants, physicians, and other supervisory clinical staff may play a role in meeting staffing requirements.
A message to U.S. Rep. Annie Kuster’s office was not returned.
The Bulletin was unable to reach the state long-term care ombudsman. Jake Leon, a spokesman for the Department of Health and Human Services, said the agency hasn’t heard much from the public about the new rule. He said the department’s Office of Health Facilities will monitor facilities’ compliance once the rule is in effect.
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