Nebraska health associations, federal lawmakers criticize nursing home staffing proposal

LINCOLN — Nebraska health associations and the state’s congressional delegation are pushing back on a proposed federal nursing home staffing rule they said could harm the state’s health care.

The U.S. Centers for Medicare & Medicaid Services proposed a new rule Sept. 1 to ensure that long-term care residents receive a minimum number of daily nursing hours and require a registered nurse to be available 24 hours a day, seven days a week. The rule would also expand resident assessment requirements.

Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services, said in a statement the rule is an “important first step” to hold nursing homes accountable and ensure that residents get the “safe-high quality care that they deserve.”

But that may not be the case for Nebraska, according to Jalene Carpenter, president and CEO of the Nebraska Nursing Facility Association, Nebraska Assisted Living Association and Nebraska Health Care Association.

She said the proposal “blatantly disregards” the workforce crisis in Nebraska, particularly in nursing homes and assisted living communities.

The Center for Medicare Advocacy also criticized the rule as insufficient and “a major step backwards.”

‘Path to closure’

Carpenter said that 53% of Nebraska’s nursing facilities would not meet the proposed nursing aide requirement of 2.45 hours per resident day and that 38% would not meet the registered nurse requirement of 0.55 hours per resident day. Only 67% of Nebraska’s nursing facilities would currently meet both requirements. A “one-size-fits-all approach would not work here, she said.

“The proposed rule is completely out of touch with Nebraska’s reality,” Carpenter said. “This proposed rule isn’t a path to quality. It is a path to closure.”

Jeremy Nordquist, president of the Nebraska Hospital Association, said all Nebraskans should be concerned about the proposed rule and the “bottleneck effect” it could have on the state’s health care system.

For example, Nordquist said, hospital patients are waiting weeks, sometimes months, to be discharged to a nursing home for rehab or long-term care — particularly in rural areas — because there aren’t enough available beds. This has strained the state’s hospitals.

Congressional delegation weighs in

All five members of Nebraska’s congressional delegation — U.S. Reps. Mike Flood, Don Bacon and Adrian Smith and U.S. Sens. Deb Fischer and Pete Ricketts — asked for further clarification in a Friday letter to Brooks-LaSure.

The letter states they are concerned about “unique compliance challenges” in rural states such as Nebraska. Nine of Nebraska’s 93 counties do not have any practicing registered nurses available, and 80% of counties’ registered and licensed practical nurses per capita are lower than the national average.

“The unique needs and challenges present in regional and local workforces show us that one-size-fits-all mandatory minimum staffing standards are not appropriate policy,” the delegation wrote.

The letter also notes concern about the proposal’s definition of “urban” areas as towns with more than 5,000 people. The lawmakers said this would block many rural, non-metropolitan areas from an extended implementation timeline meant to benefit rural long-term care facilities.

The Centers for Medicare & Medicaid Services will accept comments on the proposed rule through Nov. 6.