New staffing rules would impact local care center

Erin Mullins

Wyoming Senators wrote a letter to the Centers for Medicare and Medicaid (CMS) expressing concern over proposed legislation requiring minimum staffing requirements in nursing homes.
The new legislation requires a registered nurse (RN) to be on staff 24/7 at nursing homes as well as requiring RNs and nurse aides (NA) to work a certain number of hours per day relative to the number of patients.
“Many LTC facilities will be unable to take on these staggering new costs,” senators John Barrasso and Cynthia Lummis, R-Wyo., wrote. “We are concerned that facilities may decide it is no longer economically viable to accept government insurance, resulting in our nation’s most financially and physically vulnerable individuals being turned away from care.”
North Big Horn Hospital District CEO Eric Connell said New Horizons Care Center would “absolutely not” be closing. However, Connell said he worried that nursing homes across the country would have to shut down, including those in rural areas like Montana.
“We had a nursing home close actually in our county in Basin,” he said. “And so anytime… you mandate additional staff, the staff have to come from somewhere.
There’s costs associated with that and nursing homes that are already on razor thin margins.”
Not every nursing home makes money, Connell said. Some, like the Care Center, are subsidized by hospital operations and community support which comes through the mill levy.
While insurance like Medicare can pay for nursing home care, it does not pay for services like janitorial work.
The board is 100% committed to the nursing home for the long term, he said. It is a part of the hospital’s mission to provide nursing care, so it is not a question of if the doors will close due to CMS regulations, he said.
In order to meet regulations, the hospital will need to hire more staff, he said. Currently, the Care Center is roughly 90% of the way toward meeting the minimum requirement of nurse aides per patient per day.
The Care Center relies on LPNs, who have a lower scope of nursing practice than RNs do, to care for patients. It is common across the industry to use LPNs in long term care
centers, he said, but LPNs do not fit the bill as a “nurse” in the current regulation.
For the Care Center, the biggest issue with the legislation is that it does not account for LPNs in their staffing ratios, Connell said.
“There’s not enough nurses in health care in general to staff all of the hours that would be required. So we would have to trade out LPNs for RNs that don’t exist,” he said. ”That is a tall order to meet that requirement. That’s the first big problem that we have.”
The second biggest issue with the legislation is the requirement to have an RN 24/7, he said. Since the hospital relies on LPNs, Connell said it will be hard to suddenly “materialize” those RNs in the Care Center.
If the legislation were put into law as currently written, it would cost the hospital between $260,000 and $450,000 to meet the CMS regulations, he said. The low end of the estimate accounts for hiring two full time nurse aides and two full time RNs.
The high-end of the estimate accounts for hiring two full- time NAs and four full-time RNs.
Connell said that the regulations are well-intentioned.
“If we could have a doctor in the Care Center 24/7 to be ready to care for patients and residents, we would love that, right? But some things are more feasible than others,” he said.
Despite the good intentions of the legislation, Connell is hoping for changes.
“We’re hopeful that as they look at the comment period that there will be some opportunities for rural facilities to perhaps have inclusion of LPNs in their staffing ratios, or some other exceptions.”