There were plenty of nursing home horror stories during the height of the COVID-19 pandemic: the virus spreading unchecked, seniors left for hours without care or company, and far, far too many deaths.
The tragic, dangerous situations led President Biden to promise a major overhaul of nursing home care in his State of the Union address in 2022.
The new proposed standards for staffing levels in nursing homes arrived Friday, months overdue, and they got a mixed reception from advocates, while the long-term care industry slammed the recommendations saying the mandates would lead to facilities closing.
But one quarter is singing the proposal's praises loudly: labor unions. The AFL-CIO and SEIU, which both represent nursing home workers, lauded the Biden administration's plans.
"Nursing home workers and residents have suffered unspeakable consequences," SEIU International President Mary Kay Henry says in a statement. She calls the proposal "bold reform" that gives hope to the "woman-of-color-powered nursing home workforce" for better, safer working conditions ahead.
The specific proposals are:
- Nursing homes should have at least one registered nurse working 24/7.
- Each patient should be guaranteed 33 minutes of a nurse's time each day.
- Every resident should have about 2.5 hours of a certified nursing assistant's care every day.
- There should be at least one certified nursing assistant for every 10 residents.
The modest-sounding measures, nonetheless, would require more than 75% of nursing homes in the U.S. to hire additional staff, according to the administration.
And that's a big problem, nursing home industry representatives say.
"There are simply no people to hire—especially nurses," says Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit nursing homes and other aging services providers. "It's meaningless to mandate staffing levels that cannot be met."
In a statement, Sloan says immigration reform is needed to grow the workforce, and her members need better reimbursement rates from Medicare and Medicaid. She predicted the mandates could close nonprofit nursing homes. Nonprofit nursing homes have been at a competitive disadvantage as large for-profits chains have come to dominate the industry in recent years.
Despite union enthusiasm, Biden's effort is being called inadequate to protect seniors, even by some in his own party.
"After repeated delays spurred by industry influence, we have a weak and disappointing proposal that does little to improve the quality of care or stop the mistreatment of nursing home staff," Rep. Lloyd Doggett, a Democrat from Austin, Texas, says in a statement.
Doggett pointed out that the hours of care proposed are lower than what was recommended when the issue was last studied more than 20 years ago.
But those guidelines of 20 years ago were optional, and AARP, the organization representing older Americans, cheered this move toward an enforceable standard. "The lack of standards and poor-quality care in too many of America's nursing homes is deadly," Nancy LeaMond, AARP's chief advocacy officer, says in a statement. "Today's proposal is an important step."
The Centers for Medicare and Medicaid issued the proposed rule Friday, and the comment period on it runs until Nov. 6.
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