Statement on the CMS Unfunded Staffing Ratio Mandate

The CMS-proposed staffing mandate is not the answer to the ongoing nursing home labor shortage and will only exacerbate this workforce crisis. The mandate could push nursing homes operating on already tight budgets into closing, ultimately reducing access to care. The state has already experienced a decline in access to long term care, with 17 facilities either closing or converting to a lower level of care since the beginning of 2020. This is primarily due to underfunding and the persisting staffing shortage. While nursing homes are eager to hire more staff, the fundamental issue lies in the insufficient pool of available workers. An unfunded mandate will not help nursing homes hire more staff and will likely lead to further closures. Maine's population is the oldest in the country and is getting older. A policy like this will only further limit access to long term care, resulting in older adults and their families having to wait longer and search farther for the nursing home care they need.

This proposed rule comes at an incredibly difficult time. Nursing homes were grappling with a severe workforce shortage even before the onset of the COVID-19 pandemic, and it has only gotten worse. Across the country, the long term care sector still needs approximately 150,000 more workers to simply return staffing levels to pre-pandemic figures. Over 500 nursing homes nationwide have closed since 2020, often due to an absence of qualified staff to hire. Astonishingly, CMS estimates this proposed staffing rule would cost $4 billion annually, or roughly $300,000 per facility, but does not provide any funding to meet these steep costs. These issues are especially pertinent in rural states like Maine, where meeting the specific requirement of having a registered nurse (RN) on-site 24/7 is a formidable challenge. In fact, two-thirds of nursing homes in Maine would not be able to meet this requirement.  

The proposed rule also disregards the hard work of many nursing home care providers, such as LPNs, Directors of Nursing, and activities staff, who play pivotal roles in resident care but are not factored into the staffing ratio. Moreover, the mandate's stringent penalties and limited flexibility in addressing temporary staffing shortages reveal a lack of understanding of the operational realities of nursing homes. 

Our homes provide quality care and want more staff. This rule, however, will ultimately cause more harm than good. Instead, we call on CMS to collaborate with nursing facilities on creating policies that will help us resolve this workforce crisis.

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