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HAP, PHCA Urge CMS Not to Exacerbate Access Challenges Amid Workforce Emergency

November 06, 2023

HAP is joining the Pennsylvania Health Care Association (PHCA) in raising concerns that proposed federal regulation to establish staffing minimums in long-term care facilities would jeopardize health care access amid a historic health care workforce emergency.

In a letter today to CMS Administrator Chiquita Brooks-LaSure, HAP President and CEO Nicole Stallings and PHCA President Zach Shamberg warned that the rule would exacerbate challenges that providers already face ensuring access to care.

“To be clear, our members are committed to delivering quality care to every individual in need of acute and post-acute care,” Stallings and Shamberg wrote. “However, regulators and lawmakers must recognize the reality that health care providers face every day: there is a workforce crisis raging in Pennsylvania and throughout the United States that is threatening the stability of the care continuum.”

For hospitals—which are already contending with vacancy rates of more than 30 percent for registered nurses (RN) and nursing support staff—additional staffing pressures on nursing facilities would mean longer delays discharging patients to post-acute care settings, which strains patient care teams and increases emergency department waits. About 60 percent of nursing home providers that participated in a March 2022 PHCA survey reported that they declined hospital and non-hospital referrals during the Omicron surge of the COVID-19 pandemic that strained hospital and nursing facility capacity.

“Hospitals had nowhere to discharge patients because nursing facilities didn’t have enough staff to accept more residents,” Stallings and Shamberg wrote. “The strain of finding appropriate post hospital care––post-acute and behavioral health––is an ongoing challenge. This federal staffing proposal will only lead us further down a path of catastrophe, all in an effort to achieve arbitrary, numerical goals that don’t translate to high quality care.”

To meet the proposed federal mandate, Pennsylvania nursing homes would have to hire 900 more RNs and 2,600 certified nursing assistants (CNA) on top of the 4,000 CNAs they must hire to meet state requirements taking effect July 2024.

The letter is available online.