Ignoring staffing challenges facing nursing homes since the COVID-19 pandemic began, the Biden Administration issued a staffing mandate rejected by the Obama Administration in 2016. This one-size-fits-all approach treats all nursing homes exactly the same, without any recognition of existing quality or local job markets. New Hampshire already has one of the nation's lowest unemployment rates and does not have enough available licensed staff for all health care providers.
Effectively this unfunded mandate would force New Hampshire facilities to further deny admission to residents (one county-run facility already has a wait list of over 100 prospective residents), in order to boost their staff-to-resident ratios, or use more out-of-state nurse staffing agencies, at bankrupting cost, putting strangers by the bedside.
Where does the Biden Administration think the workers would come from? The registered nurse (RN) vacancy rate for New Hampshire hospitals is 17 percent! The state itself has paid up to $94 an hour to nurse staffing agencies for RN services as part of $11.5 million in contracts with such agencies, 14 of which are based out-of-state.
This is just one of many, many problems with this proposed unfunded mandate. The Biden Administration estimates it would cost nursing homes $4.4 billion in its first full year (at least $2 billion less than its true cost), yet is only providing a one-time "workforce investment" of $75 million (around $5,000 per nursing home). Even the president's own Small Business Administration had questioned his proposal's math, as have leading fellow Democrats.
According to the federal Medicare Payment Advisory Commission, the all-payer margin for freestanding nursing homes fell to a negative 1.4% nationally in 2022, a dismal situation MedPAC noted is “is heavily influenced by states’ Medicaid nursing home rates." There is no room within negative margins for unfunded new costs. Plus the mandate's new state Medicaid costs would have to come from New Hampshire taxpayers or be diverted from home and community-based care.
Make your voice heard, and let the Biden Administration know you oppose this new rule that would destroy long-term care in the Granite State. For a link to comment, go to https://www.whitehouse.gov/contact/.
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