Nursing Homes Say Closures Loom if Spending Bill Becomes Law


November 17, 2021 4:12 pm

Thousands of nursing homes would be forced to close and thousands of others would have to stop taking new admissions if several provisions of the Build Back Better Act become law, industry officials said Wednesday.

House Democrats’ sweeping $1.75 trillion package addresses climate, education, and numerous social programs, but it would also require nursing homes to have a registered nurse on site at all times. In addition, the legislation would impose mandatory minimum staffing requirements for all facilities a year after HHS conducts a $50 million study to determine ideal staffing levels for nursing homes.

Both provisions are well-intentioned, said Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living, which represents more than 14,000 U.S. nursing homes.

“Unfortunately, if these provisions actually became law, we believe that thousands, if not most of the skilled nursing facilities in the United States would close. And I know that’s a dramatic statement, but we believe it’s true,” Parkinson told reporters during a web briefing.

The AHCA/NCAL is urging the Senate to scrap both proposals or provide massive federal funding in order to meet the “unfunded mandates,” Parkinson said.

Nearly 187,000 residents have died from Covid-19 at nursing homes and other long-term care facilities, as of Nov. 16, according to the Kaiser Family Foundation. The carnage, along with the industry’s history of low pay, poor benefits, and difficult working conditions, has led 221,000 nursing home workers to leave their jobs since the pandemic began.

Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, is urging lawmakers to retain both provisions, which were originally included in the Nursing Home Improvement and Accountability Act that was introduced in the House (H.R. 5169) and Senate (S. 2694).

“We feel strongly that they should be maintained,” she said. “They’re necessary to move us forward in improving the conditions that exist in nursing homes and helping to ensure that residents” are properly cared for.

The House Build Back Better legislation also includes provisions to improve the accuracy of cost reports and other data that facilities submit to the Centers for Medicare & Medicaid Services. It also calls for stricter oversight and monitoring of facilities by state inspection agencies.

If the HHS study found that nursing homes need to hike clinical and direct care staff by 25%—which Parkinson said was a reasonable estimate—it would require hiring more than 150,000 registered nurses, licensed practical nurses, and certified nursing assistants at a cost of $10.7 billion per year.

“The workers are simply not there. It’s one thing to mandate that we have a certain amount of employees. But it’s completely unrealistic to do so if the employees are not there to hire,” Parkinson said.

Smetanka said the industry’s reputation is playing a part in the labor shortage.

“Certainly we are sensitive to the fact that we are seeing labor shortages right now, but the reality is that these buildings have not necessarily been good places to work,” she said.

Federal law currently requires nursing homes to provide “licensed nursing services” that are “sufficient” to meet resident needs. But Medicare only requires nursing homes to have at least one registered nurse on duty for eight straight hours per day. If the BBA’s 24-hour requirement for registered nurses becomes law, the AHCA/NCAL estimates it would require hiring 21,000 more nurses, at a cost of $2.5 billion a year.

Parkinson said his organization supports the 24-hour requirement for registered nurses—as long as it’s paid for.

Smetanka said they’ll be working with House and Senate staff to keep both provisions. “We’re hoping that common sense prevails here,” she said.