Lynda P. Goldthwaite, RN, BSN, NHA, of Salisbury has worked in health care as a registered nurse and nursing home administration and is the executive director for Peabody Place.

The recent proposed and unfunded CMS mandate for staffing standards in nursing homes will definitely impact the capability of facilities to operate at occupancy levels that support access for seniors who need care in a licensed setting, a backlog of seniors in hospitals and emergency rooms, a shift of seniors into environments that cannot necessarily meet their care needs, and closure of facilities due to significant financial losses.

Some providers have already made reductions in overall occupancy or have “closed” wings or floors because of staffing. The big picture does not bode well for the overall health outcomes of our seniors in New Hampshire.

Several factors within the mandate will further impact our state’s capability to provide excellent long-term care in the 73 facilities still providing care to a rapidly growing population.

The mandate also proposes a required 24/7 RN in every facility with few exemptions. That will be extremely difficult to achieve given that the current New Hampshire workforce data survey with a 32% response rate has reported 1,057 vacant registered nurse positions in our state. This does not include the numerous other settings that employ RN’s including physician offices, ambulatory care, and schools.

Finally, the mandate completely omits and ignores licensed practical nurses and their significant contribution in long-term care settings. LPNs are not counted in the direct care numbers within the proposed mandate. Prior to the pandemic, providers worked closely with community colleges and private educators to increase the number of LPN trainings in our state. At that time in New Hampshire, the workforce issues commanded us to create strategic and innovative solutions to help ameliorate the already significant shortage of nurses in New Hampshire. I personally feel that this was a valid solution then and continues to be critical now.

The workforce issues are multi-pronged, but completely ignoring the importance of licensed practical nurses is a huge mistake that ignorance quite truthfully might crumble the long-term care industry.

I have been a registered nurse in New Hampshire for 42 years. I have worked with and I have supervised LPNs in long-term care environments for many years. While the scope of practice of an RN and an LPN is different, it does not diminish the importance of the LPN to the nursing industry, or to long-term care.

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The quality of care of seniors does not correlate to the credentials of the nurse caring for the person; quality is inherent to the mission, vision, and values of the provider held accountable for the care.