August 6, 2014 | Mark Woodka
I just read in McKnight's that new staffing mandates are being 
considered for long-term care facilities. This proposed legislation, introduced by Rep. Jan Schakowsky (D-IL), would require nursing homes and skilled nursing facilities to have an RN in the building 24/7. Today the law requires an RN on duty for only 8 hours per day. The goal of the legislation is to improve quality of care, and having more RN presence in the facility should help to accomplish that.
Skilled nursing providers are seeing an increase in resident acuity. It was just a matter of time before a proposal like this came about. According to Schakowsky, "The need for at least one RN could not be more urgent."
While most people would argue (and at least some studies support) that higher staffing levels in long-term care and higher skill mix levels lead to better care. The challenge comes in paying for two extra RN shifts per day -- a cost that would well exceed $100,000 per year. Reimbursement cuts from Medicare and states moving to managed Medicaid have left providers so squeezed that there is little, if any, wiggle room left in their labor budgets.
AHCA has done an excellent job under Mark Parkinson’s stewardship in framing the argument around further cuts tied to quality outcomes and excluding providers achieving high quality. It would be nice if this legislation passes to have some financial incentives to assist providers. News like this is a reminder that facilities must be diligent in removing excess costs like overtime and vastly improving operational efficiencies. Fortunately, there are very real opportunities to do so.
Will we see more legislation like this? I think we will. Based on the age of our congressmen and women, I have a sneaking suspicion that many of them are starting to deal with an aging parent and are interacting with our industry for the first time. Their experiences and perceptions formed may lead to additional legislation.
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