Opinion: Nursing home staffing mandate is a bad idea for New Hampshire


Published: 08-27-2023 6:00 AM

Brendan W. Williams is president/CEO of New Hampshire Health Care Association.

Concord is home to great facility-based long-term care options, including two with a rich history. Presidential Oaks is a nonprofit that first opened as the New Hampshire Odd Fellows Home in 1882 to care for indigent men, women, and orphans (a decade later, also on Pleasant Street, the current Centennial Hotel opened as a group home for elderly women). A skilled nursing facility was added to the original Odd Fellows building in 1992, and, today, roughly half of its residents are typically on Medicaid.

Founded in 1967, Havenwood Heritage Heights is a nonprofit, faith-based continuing retirement community. It allows seniors to age in place, enjoying fully independent living or, if needed, receiving nursing home care. While most continuing care communities do not have contracts to serve the Medicaid poor, Havenwood does.

Like any facility that provides Medicaid care, these facilities do so at a loss. However, providers were very appreciative that the bipartisan two-year budget signed into law by Governor Sununu made a historic investment in Medicaid rates for nursing homes and home and community-based settings alike.

This funding could not be more imperative. National data shows the workforce for nursing and residential care facilities remains over 220,000 workers smaller than it was in February 2020 before the COVID-19 pandemic began wreaking havoc. Recovering this workforce is especially challenging given a strong overall economy with its competing job opportunities. New Hampshire hit an unimaginably low, national best, unemployment rate last month: 1.7%.

If anything, that minuscule unemployment rate exaggerates the availability of workers for certain types of employers, like healthcare facilities that need licensed staff. This is true even though wages for such workers have never been more attractive.

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The Merrimack County Nursing Home in Boscawen, to give just one example, offers a licensed nursing assistant no less than $17.50 an hour, with eligibility for a $3,000 signing bonus. But good wages and benefits cannot conjure into being workers that don’t exist.

Thus, nurse staffing agencies from out-of-state have moved in to exploit opportunities and charge hospitals, nursing homes, and even the state itself extortionist rates. And Granite Staters that need nursing home care are too often turned away, as facilities lack the staff to admit more residents.

As dire as the situation is, the federal government can make it infinitely worse by requiring facilities to hire nonexistent staff. The federal government’s morbid preoccupation with piling expectations upon nursing homes stands in stark contrast with its favoritism elsewhere.

In a February rule, it admitted it was forfeiting claim to an estimated “$2 billion in improper payments” to Medicare Advantage insurers from 2011-2017, and a June analysis by University of Southern California researchers estimated Medicare’s overpayments to such insurers may be “$75 billion or more” in 2023 alone.

In 2016, the last time it piled unfunded mandates upon nursing homes, the federal government acknowledged in its 184-page rule that mandating staff ratios would have the effect of “stifling innovation, and would not result in the improved quality and person-centered care that we seek in facilities.” It stated it did “not agree that a “’one size fits all’ approach is best” and warned, presciently, with respect to a suggested 24/7 registered nurse requirement, that “geographic disparity in supply could make such a mandate particularly challenging in some rural and underserved areas.”

Yet, seven years later, following a worldwide pandemic that cratered the care economy, the Biden Administration is going to mandate an unfunded nursing home staffing ratio. One projection estimated it could cost $11.3 billion a year. What was considered a bad idea by the Obama Administration is even less viable now.

For New Hampshire, it could only force the importation of more nurse staffing agency workers at exorbitant taxpayer cost through Medicaid. The Biden Administration cannot possibly believe having out-of-state strangers at Granite Staters’ bedsides would improve care.

For the survival of long-term care in the state with the nation’s second-oldest population, this bad idea must not be implemented.