by Rodney Rueter, President & CEO of Lutheran Sunset Ministries, and past Chair of LeadingAge Texas
Over the past 69 years, older Texans and their families have relied on Lutheran Sunset Ministries for a range of critical services, including nursing home care. Our roots in Clifton are deep: begun by Lutheran congregations in 1954, generations of families have called our ministry home.
Our ability to continue serving our rural community is threatened by a proposed staffing requirement issued by the Centers for Medicare and Medicaid Services (CMS) on September 1, 2023, as part of the Biden Administration’s focus on ensuring quality care in nursing homes. We share that goal, and as demonstrated by our history, are committed to providing the type of care we ourselves would want to receive. No mandate from a government authority has been needed to meet that mission.
Over 90% of Texas nursing homes would fail to meet the proposed standards. We could not. Already, there are times when, due to staffing needs, we are forced to limit admissions.
CMS’ proposal – an across-the-board staffing hours per resident day (HPRD) requirement – comes at a time of unprecedented workforce shortages. By CMS’ own estimates, an additional 12,639 RNs and 76,376 nurse aides are needed to meet this requirement. Particularly for providers in rural areas, this is impossible.
Last year, the Texas Center for Nursing Workforce Studies released data showing over 15,000 qualified nursing school applications were not offered admission in 2021. On average, Texas turns away more than 10,000 qualified applications each year from its nursing programs. There is not a quick solution to this shortage.
For nurse aides, we have increased pay 30% since the pandemic and still can’t hire enough nurse aides. It’s just too difficult to compete with other sectors.
Licensed Vocational Nurses (LVN) are also crucial to the delivery of our care. Yet, CMS’ mandate completely ignores LVNs, as if they have nothing to offer. That could not be further from the truth. The requirement should be a hybrid that includes these vital and caring professionals.
Then there is the financial impact of the proposal, which CMS does little to address but estimates will cost over $4 billion to implement in the first year alone (other estimates are higher, as much as $7 billion). For our ministry, it would cost us a million dollars to comply. Nursing homes, unlike other businesses, are funded through Medicare and Medicaid, and for more than a decade that funding has been woefully inadequate in Texas.
Over half of our nursing home residents are on Medicaid; we cannot charge the state more to cover these additional expenses. We would have to increase the rates of our private pay residents by two thousand dollars a month to cover this additional cost. Families cannot afford it and shouldn’t have to shoulder that burden.
If this mandate is allowed to be implemented as proposed, it could further limit access to care by affecting more than just nursing homes. The broader healthcare system will be disrupted and reshuffling the limited number of care workers available between settings won’t solve the problem.
When nursing homes close, where will residents in our community go for the care they need? Instead of ineffective new rules, the administration should invest in serious solutions to tackle the aging services workforce crisis. We are sharing the very real impact this rule will have on rural communities like ours, as well as solutions with the Centers for Medicare and Medicaid. Together, we can get it right!