Mandates are not the solution to our growing nursing home crisis

Washington often means well, but sometimes the left hand isn’t talking to the right. Such was the case earlier this month, when the U.S. State Department issued a visa freeze impacting international nurses at the same time that the Biden administration plans to soon issue a minimum staffing mandate for nursing homes.

It wasn’t the State Department’s fault — there are statute limitations on how many visas can be processed each year. Yet thousands of much-needed nurses are unable to enter the country now. It is an example of a key missed opportunity to help bolster our long-term-care workforce, and how Washington is leaving real solutions to address the labor crisis on the table.

Nursing homes are eager to grow their workforce but are still in the process of rebuilding after COVID-19. The sector lost nearly 250,000 workers over the course of the pandemic — more than any other health care sector. The total number of individuals working in nursing homes today has dipped down to levels not seen since 1995. Even though providers are doing everything they can to try to recruit new caregivers, they struggle to find qualified applicants, as well as to compete against hospitals and other employers due to limited government funding.

We are seeing the consequences of our labor crisis in real time. Nursing homes limiting the number of residents they can accept is becoming all too common. For others, staffing shortages are leading to the devastating decision to close entirely. Vulnerable residents are being forced to relocate, disrupting the continuity of care and moving them farther away from their beloved family and friends. In rural states, closures have been rampant. In the Sunflower State, where I also served as governor, the 52nd nursing home since the beginning of the pandemic shut down last month.

Yet Washington’s response is a blanket staffing mandate, currently unfunded and without any supporting workforce development programs. This one-size-fits-all regulation is counterproductive and in no way addresses the underlying issue of our persistent workforce challenges. To truly solve our labor crisis, we must start with the core need: proactive measures that will support workforce recruitment and retention.

One potential solution lies in common-sense immigration reform. One in six registered nurses and one in four direct care workers in the U.S. are immigrants, and research has found that increased immigration has a positive effect on patient outcomes. While it’s not a silver bullet, streamlining the immigration system for health care workers can help us tap into a global talent pool and boost our workforce. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) supports the recently introduced DIGNITY Act, which would improve visa processing, as well as the reintroduction of the Healthcare Workforce Resilience Act, which would recapture unused visas from previous fiscal years for nurses and their families.

Next, adequate funding is essential to invest in the careforce and offer better-paying jobs. Most nursing home residents rely on Medicaid, but the program only pays about 86 cents on the dollar. The combination of chronic Medicaid underfunding and record inflation has placed an undue financial burden on nursing homes that are already struggling to keep their doors open. Labor is a nursing home’s biggest expenditure, and it’s only become more costly as nursing homes stretch every dollar to raise wages and hire more staff. Proper Medicaid funding and fully funded regulations will give facilities the resources they need to offer competitive pay and benefits and successfully recruit more caregivers to the field.

Moreover, we have to address the country’s nursing shortage, help train the next generation of caregivers and incentivize them to choose a career in long-term care. Congress has introduced two bills that would assist in this regard. The Building America’s Health Care Workforce Act would offer temporary nursing aides who stepped up to serve our nation’s seniors during the pandemic a realistic path to become certified nursing assistants (CNAs). The Ensuring Seniors’ Access to Quality Care Act would allow more nursing homes the ability to offer in-house CNA training programs. Additionally, AHCA’s Care for Our Seniors Act proposes several policy solutions that incentivize health care professionals to choose a career in long-term care, including tuition reimbursement, loan forgiveness and housing and childcare assistance. Implementing programs and solutions such as these can grow our workforce substantially.

A federal staffing mandate alone does not guarantee the availability of qualified staff, and arbitrary ratios vastly oversimplify the complexities of our crisis. The biggest challenge is that in today’s labor market, the workers simply aren’t there. A staffing mandate will not create applicants. And when nursing homes cannot meet this impossible standard, they will have to reduce the number of residents they serve or close entirely, exacerbating the current access to care crisis we’re already seeing unfold.

We all want to increase the nursing home workforce to ensure our residents have the support they need and that our valued caregivers are not run ragged. Let’s not leave real solutions on the table, and let’s work together to address our recruitment and retention challenges. Through meaningful investments and policy solutions, we can build a better future for our residents and caregivers.

Mark Parkinson is the president and CEO of the American Health Care Association and National Center for Assisted Living and the former governor of Kansas.