Federal regulatory agencies should aspire to follow the Hippocratic oath that doctors swear to uphold: First, do no harm. They should avoid cures with unintended consequences that are worse than the original problem.
As a nurse who has taken a similar oath, I can assure you that the nursing home regulations issued in April by the Biden administration fail this standard. Despite bipartisan opposition in Congress and dire warnings from sectors across the health care continuum, the administration is moving forward with a staffing mandate that’s utterly disconnected from reality and will do real harm to all involved.
The new mandate, which is scheduled to take effect in coming years, would require nursing homes to have registered nurses around the clock. Sounds simple — even desirable — but it actually will harm America’s seniors by decreasing access to nursing home care that many desperately need.
Georgia has a shortage of nurses, and despite true efforts at the state level to increase the pipeline of nursing students, we’re still far from closing that gap. Our state has some of the lowest registered nurse-to-population ratios in the nation, and studies suggest that the health care workforce shortage will only worsen in the coming years. This explains why hospital groups nationally oppose this regulation even though it doesn’t apply to them directly. All health care providers are competing for nurses at a time when there aren’t nearly enough to fill open positions.
Credit: Images by Amie Photography
Credit: Images by Amie Photography
A study performed this year by the American Health Care Association found that this unfunded mandate would force Georgia nursing homes to hire an additional 3,500 nurses and nurse aides at a cost of $218.5 million a year. Yet, the Biden Administration isn’t offering any corresponding resources or funding to help build a pipeline of new caregivers. This presents quite a quandary as nursing homes are forced to hire workers who don’t exist with dollars they don’t have.
It’s easy to see what will happen. Homes will reduce capacity. Some will close completely. Most in danger are those in rural areas where there are few registered nurses to be found. Vulnerable seniors and their families will be left scrambling to find care further from home.
An excessive regulatory burden combined with the devastating effects of the pandemic have already diverted attention from where it should be. To achieve safety and quality, focus must be at the bedside. As administrations and political agendas shift and change, providers are left scrambling to pivot and catch up. Competing priorities from new and expanded regulatory requirements have consumed resources that would be better devoted to quality and innovation.
Over the past few years, the Georgia Health Care Association has heard from countless dedicated professionals who have decided to transition to other jobs and care settings because the demand to keep up is simply overwhelming. The impact of losing compassionate and tenured leadership and caregivers in long-term care is immeasurable, and these dedicated professionals desperately need meaningful support to confront the challenges an aging society and dwindling workforce bring.
The Biden administration, various stakeholder groups and media continue to promote a narrative that suggests the pandemic exposed inadequate and often horrendous staffing in nursing homes. This fails to acknowledge the fact that federal guidelines forbade many nurses from working for a specified period of time if they were symptomatic or tested positive. That problem combined with mass resignations because of fear or exhaustion certainly caused a staffing crunch as compared to pre-pandemic times.
The focus on registered nurses impugns the professionalism of the licensed practical nurses who serve patients incredibly well every day. The shuffle of workers that would result from this change would downgrade many LPNs from their current scope of practice. LPNs will not — and should not — accept a career trajectory that’s taking them backward. As a result, many will choose to leave our specialized care setting or, worse, leave the profession altogether.
Further, agency utilization will increase, as happened during the pandemic. The result was exorbitant costs, poor resident, family and staff satisfaction and a deleterious effect on person-centered care delivery and quality outcomes.
With this one-size-fits-all approach that is focused on numbers, there’s real concern that providers will simply hire to fill a vacancy as they chase a number for compliance versus recruitment of top talent that shares in the mission of promoting and preserving residents’ dignity, highest level of function and quality of life. It has long been referred to as the warm body syndrome, and there are no winners when that is the driving tactic. It heightens the potential for poor staff morale and the risk for abuse, neglect and exploitation.
A federal regulation ostensibly aimed at helping seniors will do the opposite. It will result in fewer nurses in the profession, fewer beds and more American families struggling to find skilled nursing care for their loved ones. Instead, the focus should be on common-sense solutions to enhance the long-term care workforce and ensure access to quality care for seniors.
Pam Clayton, a registered nurse, is the vice president for quality advancement and regulatory affairs for the Georgia Health Care Association.
