Most NH nursing homes won't meet new staffing rule and doubt they can do so

A new analysis by one of the nation’s leading health policy research organizations confirms what the state’s long-term health care providers have been warning: the state’s nursing homes are don’t have enough staff to meet the Biden administration’s new staffing rule.

According to KFF’s analysis released last week, only 26 percent of New Hampshire’s long-term nursing facilities, or 19 out of 73, could meet a new rule from the Centers for Medicare and Medicaid Services with current staffing. KFF noted that CMS estimated that filling the staffing gap would cost the nation’s nursing homes: $43 billion within 10 years of the final rule taking effect.

“It’s just impossible, especially in a rural state like New Hampshire,” said Brendan Williams, president and CEO of the New Hampshire Health Care Association. “You just can’t find these people. You can’t find certified nursing assistants. You can’t find registered nurses.

Most NH nursing homes won’t meet new staffing rule and doubt they can do so

Patients and their families told CMS they support this rule as a way to improve patient care. A Milford clergy member was among those who submitted nearly 50,000 comments on the rule after it was first proposed in 2023.

“I have witnessed the difficult conditions in various nursing homes due to understaffing,” wrote the Rev. Hays Junkin. ” It’s tragic ; our seniors and those who care for them deserve a safe, well-staffed residence. I urge you to push for adequate staffing and ignore opposition from the care home sector.

The current Centers for Medicare and Medicaid Services staffing rule requires 24-hour clinical staffing and sets standards for patient care, but gives facilities discretion over staffing details. For example, in most cases, a facility must employ a registered nurse for at least eight consecutive hours per day, 7 days per week.

The new rule, which is expected to take effect in 2026 for urban facilities and 2027 for rural sites, requires a nurse to be on call 24 hours a day, seven days a week. Each patient must receive 33 minutes of care per day of a registered nurse and 147 minutes of care from a nurse’s aide. Institutions could apply for “hardship” exemptions if they met several requirements.

KFF’s analysis found that New Hampshire is closest to meeting registered nurse staffing requirements, with 79 percent of facilities able to provide each patient with 33 minutes of care from a registered nurse each day. Only 30 percent of facilities meet requirements for nurse aides, according to the report.

Williams said CMS’ new “one size fits all” staffing rule ignores New Hampshire’s “workforce crisis hellscape” and the scarcity of affordable housing and child care that makes recruiting new workers difficult . Additionally, the state’s unemployment rate is low and Medicaid reimbursement rates fail to cover the cost of care, he said.

Nursing facilities across the state are already limiting admissions because they don’t have the staff to fill all their beds. Williams said following the new staffing rule would leave long-term care facilities without good options. The state and counties should raise taxes. Private establishments should charge more. Or the facilities will close.

Critics of the rule include U.S. Rep. Chris Pappas, who joined a number of other members of Congress in expressing concerns to CMS twice in 2023, before the rule was finalized, regarding the impact on nursing facilities.

“We believe the rule as proposed is too burdensome and will result in additional closures and decreased access to care,” he wrote. He continued: “We recognize CMS as a critical partner in identifying, mitigating and preventing future health and safety issues in nursing homes. We are ready to work with your agency on proposals to improve long-term care for patients.

In an email last week, Pappas said he continued to have concerns and was disappointed that CMS did not incorporate feedback it relayed from concerned health care providers to the New Hampshire.

“I have the utmost confidence in New Hampshire’s healthcare workers who are doing incredible work keeping our communities healthy, and I remain committed to supporting access to high-quality care for people residing in nursing homes,” Pappas said.

He added: “Without additional support from Congress and CMS for our long-term care facilities and seniors, these new regulations could have a serious impact on a long-term care system already under enormous strain . We must provide long-term care facilities with the resources and funding necessary to stay open, recruit and retain a strong workforce, and provide residents with the best care possible.

Gov. Chris Sununu also raised concerns and joined 14 other governors in 2023 to call on the Biden administration to drop the rule.

Senators Jeanne Shaheen and Maggie Hassan were two of three Democrats who joined nearly 20 Republicans and independents that year to urge CMS to pause and rethink the rule.

A spokesperson for Hassan’s office said she and Shaheen are evaluating changes to the rule made by CMS since it was first introduced.

These include a phased approach to give facilities more time to complete initial staff assessments; a new exemption for facilities that would not be able to meet the registered nurse requirement; and clarification that physician assistants, physicians, and other supervisory clinical staff may play a role in meeting staffing requirements.

A message to U.S. Rep. Annie Kuster’s office was not returned.

The Bulletin was unable to reach the state’s long-term care ombudsman. Jake Leon, a spokesman for the Department of Health and Human Services, said the agency hasn’t heard much from the public about the new rule. He said the department’s Office of Health Facilities will monitor facilities for compliance once the rule is in place.