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Nursing home industry rebukes new federal rule on minimum staffing requirements


On Monday the Biden administration finalized a rule that establishes staffing minimums at nursing homes that receive Medicare and Medicaid funding. Xavier Becerra, Secretary of the Department of Health and Human Services, told NPR last fall that the rule is meant to define standards for the industry.


XAVIER BECERRA: It's been the Wild, Wild West when it comes to quality and accountability at nursing homes throughout the country. What we're simply saying is we don't want Wild, Wild West when we send our loved ones.

DETROW: The rule has been met with backlash, including from the American Health Care Association, which represents the nursing home industry. In a statement, President and CEO Mark Parkinson called it, quote, "an unreasonable standard that only threatens to shut down more nursing homes." Mark Parkinson joins me now. Welcome to ALL THINGS CONSIDERED.

MARK PARKINSON: Good to be here.

DETROW: So, you know, according to the White House - and I'll just read a quote here from their announcement of this. "Under the new rules, the average nursing home, which has around a hundred residents, would need to have at least two RNs working each day and at least 10 to 11 nurse aides." In addition to that, nursing homes are going to have several years to comply with this. There is an application for hardship exemptions. Can you walk me through why that is unreasonable in your point of view? What is your concern here?

PARKINSON: There is a shortage of nurses across the country, but it is the most acute in skilled nursing facilities. The administration has done nothing to help us with this staffing crisis. And then to add on top of that, a requirement that we need to hire an additional 120,000 nurses - which is what the number is - would make it impossible. So it - we're not against more staffing. Believe me. Every nursing home in the country out there right now is hustling and advertising to get more staff. But what we are against is an impossible policy that, when it is enforced, will cause hundreds and possibly thousands of nursing homes to close.

DETROW: I just want to clarify right now. Is your point of view mostly that this is impossible to achieve or that the increased staff is not necessarily needed or wouldn't necessarily make care better? Which one is it, or is it a bit of both?

PARKINSON: We believe that more staff makes care better. The reason we're against it is because it's impossible to achieve. It is not possible to get these nurses. They're not out there. And the proposal is not paid for.

DETROW: The Kaiser Family Foundation did a study on this, found that about 80% of all nursing homes would have to hire more people to meet the new standard. Does that feel right to you?

PARKINSON: We think it's probably more like 95%. So it's somewhere 80 and 95% of all the facilities are unable to meet the requirement right now.

DETROW: Look. Big picture, NPR and so many other news organizations have reported on conditions in nursing homes. And there's been a lot of concerns - you know, residents experiencing bed sores, dehydration, malnourishment, falls, other things. We all know how hard COVID hit the nursing home community. We've been talking a lot about the staffing here. What are the big-picture solutions besides staffing - besides increasing staffing from your point of view?

PARKINSON: I think the big-picture solution is really the course that we were headed on before the pandemic, which is to look at the quality measures that are out there, trying to figure out what are the things that really matter in terms of the care that's being provided in a facility. And you mentioned some of them - falls, return to home, pain that a resident is experiencing, person-centered care, holding buildings accountable that aren't doing well on those metrics, weeding out the poor providers and really promoting and uplifting the good providers. And we've been on a good momentum to do that. If you look at the 20 quality measures that are out there on nursing homes, they have improved over the years.

Now, we definitely had a setback with COVID, which, you know, hopefully is a once-in-a-lifetime type experience. But now that that's behind us, the sector is really recommitted to a data-driven approach, not just, you know, making decisions based on anecdotes but a really data-driven approach to make sure that we continue to improve those quality measures.

DETROW: That's Mark Parkinson, President and CEO of the American Healthcare Association. Thank you so much.

PARKINSON: Thank you for having me. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Kai McNamee
[Copyright 2024 NPR]
Sarah Handel
[Copyright 2024 NPR]
Scott Detrow
Scott Detrow is a White House correspondent for NPR and co-hosts the NPR Politics Podcast.