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Nursing Home Industry Says They Won't Let It Happen


One of our West Virginia colleagues called our national team's attention to this Sept 1 letter from the President and CEO of AHCA/NCAL where he is rallying the industry to defeat the proposed minimum staffing standards from CMS by flooding the comments, lobbying legislators, and basically shouting over people like us, the consumer. "We can't let it happen and we won't", he says. He very much wants to do the right thing . . . for facilities.

I apologize in advance for the sardonism in this post but reading and hearing the exact same scripted phrases again and again from provider reps, facilities, and legislators is like living out our own long-term care Groundhog Day every time I get on social media or rewinding an AHCA/NCAL jack-in-the box every time I read McKnights Long-term Care News.

AHCA/NCAL actually began lobbying against the proposal long before it was ever released. In fact, the industry's bombardment of objections began back in February of 2022 when the Biden administration announced what was supposed to be the most aggressive protections in long-term care since the 1987 Nursing Home Reform Act. Of course, what was actually released by CMS was much more watered down than what was announced in Feb 2022 but still too much for the industry to stomach.

The CMS comment period is over and if you want, you can go browse some of those 30,000 comments. OUCH! But the industry's campaign against the proposal has not slowed and none of us should expect it to until they have crushed this proposal.

Some key take-aways from the Sept 1 letter as that 60 day public comment period was getting underway:

  • The focus here is on winning, not on doing what is right or fair or safe or best for long-term care residents, only what is best for the industry.

  • They will FIGHT and they will WIN. Okie doke. We believe you.

  • I've replied to AHCA's social media posts periodically that they are neglecting to mention the annual and perpectual waivers for good faith efforts to comply. Well, this memo explains why they are never mentioned: the waiver process is "cumbersome and not user-friendly" so . . . they want no staffing standard for anyone at all cuz it's too much trouble for the ones with a hardship that could apply for a waiver. Got it.

  • Penalties for non-compliance. How much of a threat and expense are they really? Surveys are slow to take place when complaints are filed and err on the side of the facility. And in the case of staffing, facilities will take advantage of the WAIVERS. We saw hundreds and hundreds of different kinds of waivers during the pandemic and facilities didn't hesitate to use them. Why would they if they experience a hardship that threatens to shutter the doors? Because it's not user-friendly? All facilities must do is demonstrate a good faith effort to hire and demonstrate a financial commitment to hire. "Here's where I have budgeted for my staff and here is how I have made attempts to hire them". Done!

  • The memo also mentions those pesky disclosure requirements: "transparency on the percentage of Medicaid payments spent on compensation for direct care workers and support staff for services in nursing and other facilities." Y'all this is accountability to us. It is not a bad thing. Sooner or later, though, someone will claim this as part of the "unfunded" and "unreasonable" cost associated with the proposed rule we keep hearing so much about.

I'm sharing all this because no single group can negotiate with a giant alone. There are over 3000 families in our Texas Caregivers for Compromise group but unfortunately, when a loved one dies, the family often no longer feels a need to advocate. However, we also have advocates across the country in groups like Voices for Seniors, the Long-term Care Community Coalition, Nursing Home Lives Matter, The Essential Caregiver Coalition, F.A.C.E., a Caregivers for Compromise in every state, and I can't even remember the rest.. We must contact our legislators as their constituents and tell them what is happening as a result of short-staff. And, we need to help National Consumer Voice get the word out that there is a residents' side to this story and the consumers' side and the family members' side, and the taxypayers' side and the caregivers' side. Most importantly, there's a human side. It's not all about money.


We are Texas Caregivers for Compromise and we are #notgoingaway.

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