Late last month, the Biden administration announced new staffing regulations for nursing homes that receive federal funding.

The mandate requires all nursing homes that receive Medicare and Medicaid funding provide at least 3.40 8 hours of nursing care per resident per day.

A majority of the care would come from nurse aides and almost an hour from registered nurses.

The new regulations also require nursing homes to have a registered nurse on site.

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The Centers for Medicare and Medicaid Services say facilities have 3 to 5 years to comply.

Nursing home operators are pushing back on the mandate.

The American Health Care Association calls it an unreasonable standard that only threatens to shut down more nursing homes.

Earlier this week, we heard from long term care providers here in Kentucky who said they already struggle to fill open positions.

Unfortunately, we just they're not in the pipeline.

I don't know that this is a problem that we can just throw money at that frankly, the people aren't there, so the workforce isn't there.

Even if we had, you know, an exhausted amounts of money, there's just no one to pick up these roles.

Our challenge with this mandate will be recruitment and retention of our ends, specifically because we're up against the hospitals who have all of the new and shiny they are aware new nurses a lot of times tend to want to be and their pay and compensation and even the benefit packages that these large hospitals can provide are unique and are a challenge for facilities like ours, particularly like us as a nonprofit stand alone facility.

There's a small pool of people.

How do we get that pool of people interested to work in an environment like ours?

But patient centered groups like the Nursing Home Ombudsman's agency of the Bluegrass say the minimum staffing mandate is long overdue and doesn't go far enough to meet the needs of nursing home residents.

They also question claims by the nursing home industry that the new requirement are too difficult to meet and would financially devastate many facilities.

About 40 to 50% of complaints that the ombudsman work are about direct care issues.

Somebody's not answering a call bill in a timely manner, not getting assistance to the toilet and having incontinence accidents, people not providing oral hygiene, which we know even more today, is so important to overall health people not providing grooming services or assistance with those just very basic activities of daily living like medications or showering, things like that.

A lot of the complaints are because there aren't enough staff or staff aren't able to respond to needs and requests for assistance.

There have been advocacy groups working since the seventies to try to implement a minimum staffing standard in federal nursing homes.

And so we see this as a really good first step.

We were very excited about the 24 hour and requirement because a lot of we we manage calls from residents who call their facility ombudsman at, you know, 8:00, 10:00 at night and say, I don't feel well, I need to go to the hospital.

And they're not letting me.

They're not calling an ambulance.

Nobody's come to check on me.

And so we know we know that there are medical emergencies that happen 24 hours a day.

It's not limited to those 8 hours that an hour and is required to work currently.

So we were very excited about that.

We were disappointed in the 3.48 number, primarily because we know through decades of research that most residents need a minimum of 4.1 hours of direct care per day.

And that's just to avoid negative health outcomes.

That's just to maintain where they are currently.

It's not to have the best life.

It's just to avoid those negative health outcomes.

And so we acknowledge the difficulty in finding people is an across the board issue.

But I don't believe that people don't want to work.

I think that health care's always bringing people into their industry and it's just nurses are leaving seniors or leaving staff or leaving because the job quality is poor.

When you have a shortage and you're competing, I think you're acknowledging that that you're not providing the best job quality to keep people in that role, which is truly affecting all of long term care.

Staffing administrators last only about a year.

Our nurses have a high rate of turnover.

It's something along the lines of 52%.

And then seniors have a nearly 100% turnover in some nursing homes.

So it's a it's a churn issue.

It's a retention issue.

I'm really interested in the Medicaid transparency piece of the bill that requires states to gather information about what percentage of a medicare payment to a nursing home is going to direct care staff going to resident care.

There is money.

You would not be a for profit company.

You wouldn't be a private equity firm and buying a nursing home if there was not money.

And more and more private equity firms bought up nursing homes during COVID than any other time.

The health care associations are certainly making a good argument for increasing the Medicaid reimbursement.

But before we take that step, I just I just absolutely believe we need to know where those dollars go now because it's $1,000,000,000 industry.

So before that, we need to figure out the transparency that we need from nursing homes.

We already require transparency from nearly every other federal contract that you could receive.

We need to make sure that we are requiring requiring transparency and then following up to review those cost reports and see where the money is going.

The new mandate was discussed last week at a US House Energy and Commerce Subcommittee on Health hearing.

At the hearing, Kentucky Congressman Brett Guthrie, who chairs the subcommittee, spoke out against the new rules, saying in part, I'm extremely concerned about two of these rules in particular the nursing home minimum staffing rule and the Medicaid access rule, both of which threaten access to long term care services for Medicaid beneficiaries by setting arbitrary staffing and pay standards.

He went on to say, While I agree that we need to do more to ensure our front line caregivers and clinical care providers are compensated commensurately with the care they're providing and offer a better quality of life for our most vulnerable.

This approach simply won't work.

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