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Reynolds should support nursing home staffing rules
Savannah Hinze
Dec. 10, 2023 5:00 am
It’s not hard to understand how Gov. Kim Reynolds has become the most disliked governor in the nation once you know her policy positions on even the most common sense issues.
A recent example is her decision to join a letter opposing a new proposal from CMS (the Centers for Medicare and Medicaid Services) that would create a new minimum staffing standard for nursing homes across the nation. Currently, there is no staffing rule, which means that nursing home operators can staff their facilities however they want, even if it means some residents — elderly people and people with disabilities who are at their mercy — are left alone for hours or even days to suffer through incontinence, immobility and confusion without any oversight.
Reynolds’ excuses, made on behalf of the for-profit nursing home industry, make little sense to anyone who is really trying to solve the problem of caring for the fast-growing population of seniors that will soon overtake states like Iowa. That’s because while the for-profit providers are rabidly objecting to regulations that would protect consumers in their care, they aren’t telling the full story about staffing. Neither is Reynolds, in acting as their mouthpiece despite the fact that the for-profit providers already have an outsized role in the nursing home industry, outnumbering nonprofit homes nearly three to one.
There’s a significant gap between for-profit and nonprofit nursing home providers when it comes to staffing. Most nonprofit nursing facilities are already meeting the staffing standard proposed under the new CMS proposed rule. In fact, on average, nonprofit nursing home staffing exceeds what is being proposed. A 2023 staffing study commissioned by CMS found that nonprofit homes on average staff 23% higher than for-profit homes. Consumer Voice’s state by state analysis of CMS's Payroll Based Journal staffing data found that in all but one state, nonprofit nursing homes reported staffing levels higher than for-profit homes.
This data shows higher staffing is possible, contradicting the claims of the for profit providers. But attracting and retaining staff will require increasing the ridiculously low pay for care workers and that will likely cut into nursing home profits. Rather than funnel $100 billion a year that nursing homes get from Medicaid for patient care into higher profits, the new rule would require these providers to put the funding into staffing.
Better staffing means better care for residents and lower risk of injury for both the staff and the patients. Proper staffing is itself a tremendous incentive for workers who want to stay in the field. Staffing in health care facilities fundamentally shapes working conditions including safety. The largest health care workers strike in history, the Kaiser Permanente strike that just ended, was essentially driven primarily by short-staffing that has placed unsustainable burdens on care workers that put them in danger in the workplace.
But avoiding harm is just the first step in working toward higher quality care. Good wages and working conditions for care workers cannot be divorced from good care for residents or patients. Research finds that having enough nurses and aides is the strongest predictor of whether nursing home residents will thrive or face early death from neglect or injury that enables people to get sicker, faster or worse, die prematurely. Given that, anyone who has a relative in a home or may end up in one themselves should support the staffing floor and all efforts to build on it for the future.
And if that’s not persuasive enough, then take a look back at COVID, when we all got a glimpse of what happens when short-staffing fails to meet basic needs for both workers and residents. Roughly one in five COVID deaths was in a nursing home — around 200,000 staff and patients in long-term care facilities died during the pandemic. Many of those deaths were tied to neglect.
The state of our nation’s nursing homes is shameful and Americans know it. Over 70% of people would not want to be admitted to one. That’s a sad statement for a wealthy nation where people over the age of 65 is the fastest growing segment of the population.
Aging Americans and their families deserve better than living out their golden years in a nursing facility where they can’t even get basic needs met. Nonprofit nursing homes provide some hope that appropriate staffing and all the benefits that come with are achievable. Reynolds should get on board instead of rejecting a CMS proposal that takes steps in that direction. As governor of Iowa, her job is to fight for patients — not protect the profits of the providers at their expense.
Savannah Hinze is a Des Moines-based Realtor and moderator of a nursing home forum.
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