Kentucky lawmakers voice concerns about proposed changes to federal nursing staff rules

FRANKFORT — Lawmakers expressed concern Thursday during a meeting of the Medicaid Oversight and Advisory Committee that proposed federal staffing mandates for nursing facilities could lead to severe challenges in Kentucky.

Those who operate nursing facilities told legislators they have been dealing with staff shortages exacerbated by COVID-19, and the proposed changes will make matters even more difficult for them.

“I am averaging $118,000 net loss each and every month of this year. If we don’t get some help within months, we’re going to go out of business,” said David McKenzie, owner of The Jordan Center in Louisa, which has suffered from staffing challenges amid the pandemic.

Becky Johnson, president of the Kentucky Association of Health Care Facilities and the Kentucky Center for Assisted Living, said she does not know where all the personnel will come from to meet the proposed mandates for the federal 2023 fiscal year.

According to her testimony, current federal regulations require nursing homes to provide licensed nursing services 24 hours a day, with a registered nurse on staff for at least eight consecutive hours a day, seven days a week.

Kentucky’s total nursing hours – which include staffing by registered nurses, licensed practical nurses and aides – is above the national average with 3.78 staffing hours, Johnson said. It would cost providers nearly $10.1 billion annually to meet the minimum staffing if the federal mandates require 4.1 hours per patient day, Johnson said.

She cited a study from the American Health Care Association showing that nursing homes would have to hire an additional 187,000 nurses and nurse aides.

Karen Venis, chief executive officer of Sayre Christian Village in Lexington, said the proposed changes are worrisome.

“For us, the concern is where are the people going to come from,” she said. “I think for our team it’s just going to add another layer of pressure that already exists. Next to a nuclear power plant we’re one of the most heavily regulated industries out there.”

Sen. Ralph Alvarado, R-Winchester, said if facilities close, it would be catastrophic and cause some people to seek care at hospitals. He said medical providers who don’t spend any time in nursing homes often have no idea that nursing homes face much stricter requirements.

“I live it. I see it every day, and it’s coming very, very soon, where you’re going to have facilities that are major employers in our communities and a lot of those folks will be suddenly unemployed,” he said.

Finding qualified medical personnel to fill the jobs can be very difficult, Alvarado added. “These are individuals who choose where they want to work, and if they don’t want to work in that setting, we can’t force them to work in the setting.”

Rep. Lisa Willner, D-Louisville, also expressed concerns.

“It’s overwhelming and it’s daunting – the challenges we’re facing, and I hear so often about the health care force dwindling because people are leaving,” she said.

Co-chair Sen. Stephen Meredith, R-Leitchfield, said information about how inflation is affecting nursing facilities would be helpful along with the development of a five-year plan to address staffing issues.

“Maybe as legislators and industry leaders, we need to talk about what the ideal staffing ratio is and develop like a five-year plan as to how do we get there rather than just throw it out there because all the issues you’ve identified are certainly real and they’re challenges,” he said.

Sen. Danny Carroll, R-Benton, said long-term facilities are not the only groups facing higher labor costs. He also suggested that the health facilities association and the assisted living center think about including child care facilities as part of long-term facilities.

“I think it’s important to remember also the effects that our long-term care facilities are feeling and their reaction having to increase pay. There’s a trickledown effect of that to other types of providers. It’s running a day program. You know we have had to increase our pay for (certified nursing assistants) tremendously,” he said.

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