Staffing requirements for nursing homes must be maintained

On March 1, 2022, President Biden announced a historic effort to protect nursing home residents and staff in his State of the Union address. After more than two years of public input, expert consultation, and careful consideration, the President announced minimum staffing standards for nursing homes that voluntarily opt-in for Medicare and Medicaid reimbursement.

In addition to enforcing minimum staffing standards, the rule mandates increased transparency in Medicaid spending and ensures that all nursing homes use evidence-based, data-driven practices when assessing resident needs, providing the most significant protections for nursing home residents and staff in decades.

The new nursing home staffing mandates are currently under threat in Congress.

Here in Aroostook County, we say, “Put wishes where spine belongs,” which is why I am calling on Senators Susan Collins and Angus King to do the right thing and oppose joint resolutions HJ Res. 139 and SJ Res. 91, which are threats to new nursing home staffing mandates. If passed, these extreme resolutions will have dire consequences for nursing home residents and the staff who care for them.

I am a registered nurse with over 40 years experience in the profession. Twenty years ago, in 2004, I started work in a for profit nursing home after 25 years of nursing experience in cardiac telemetry, neurosurgery and oncology, and working in acute care settings in a great teaching hospital.

I was shocked to discover that I was the only licensed nurse for the entire shift, caring for 40 patients. Even though there were competent and caring nursing assistants, the care of 40 patients was still my responsibility, my qualifications. I stayed there for several months, learning how a for-profit nursing home worked and providing the best care I could. It was unsustainable and dangerous. What was being asked of me was unethical and dangerous.

The American Nurses Association Code of Ethics is a guide for practicing the art and science of nursing. Her experience of a direct threat to her ability to provide safe nursing care in a for-profit nursing home led her to pursue a doctorate in nursing with a focus on health policy and gerontology.

From there, I became a teacher in nursing school and spent the next 12 years teaching young nursing students to never put themselves in the situation I was in. I had years of experience, but it wasn’t enough to operate safely with such a dangerous staff. If a new nurse came out of school and found herself the only nurse with 40 patients, the results would be dire for both nurse and patient. If no nurse wants to be in that situation, blame me and the voices of reason that were coming from nurses who were in such a dangerous situation.

The new mandates for nursing homes were the help we were waiting for and we welcomed it. What is happening now is crushing the spirit of every nurse I know.

Lawmakers in both chambers have introduced a joint resolution under the Congressional Review Act to overturn the rule, and the Senate bill, led by Sens. Jon Tester (D-Mont.), James Lankford (R-Okla.), and Joe Manchin (R-Ind. and Virginia), is reportedly likely to pass the Democratic-controlled Senate.

Tester is reportedly seeking reelection in a Republican-leaning state and is one of the Senate’s weakest Democrats. He has been outspoken about the need to stop the rule from going into effect. Last fall, he and Lankford sent a letter to the Centers for Medicare & Medicaid Services urging it to repeal the rule. The letter was signed by Democratic Sens. Maggie Hassan (NH), Jeanne Shaheen (NH), Collins and King.

The final rule provides numerous opportunities for exemptions and hardship exemptions for nursing homes and provides for a long phase-in period. The nursing home industry has had many opportunities to provide input. The industry has also spent millions of dollars in advertising and lobbying to block the new staffing standards. Senators Collins and King, please stand with nursing home residents and staff and have the courage to do the right thing by rejecting these extreme resolutions.

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