EDITORIAL: New federal rules for nursing homes won't work in rural areas

A pending federal mandate designed to improve safety and quality of care in Medicare- and Medicaid-certified long-term care facilities actually could force the closure of many such facilities, especially in rural areas.

The mandate by the Biden administration takes aim at chronic staffing shortages at these facilities, but it doesn’t come with extra money to implement the plan.

That’s probably the biggest concern. No one is against the best care of senior citizens, but the money involved is substantial, and many Oklahoma nursing home officials say they can’t meet the mandate because the staff needed doesn’t exist and is out of their reach financially.

The rules, according to a report from StateImpact Oklahoma, will require:

• Facilities to provide a minimum total of 3.48 hours (3 hours and 29 minutes) of direct nursing care per resident, per day.

• The 3.48 requirement must include .55 hours (33 minutes) of care from a registered nurse per resident, per day, and 2.45 hours (2 hours and 27 minutes) from a nurse aide per resident, per day.

• Facilities to have a registered nurse on site 24/7.

Currently, Oklahoma nursing homes operate with a staff ratio ensuring residents get 2.9 hours of direct care service, per day. The state also requires a licensed nurse on duty eight hours a day, seven days a week on the day shift.

An analysis by CliftonLarsenAllen, LLP, a professional services firm, shows the new rules would require state nursing homes to hire more than 1,200 full-time employees, including 538 nurse aides and 715 RNs over the five years the rule is phased in. That would cost Oklahoma nursing homes an estimated $76 million per year.

The big question remains, where is that money coming from?

These facilities already are underfunded by Medicaid, which compensates them at an average of $224.64 per resident, per day. According to the Oklahoma Health Care Authority, the cost of treating a typical resident in a skilled nursing facility will be $269.22 per day in FY 2025.

As Steve Buck, CEO of Care Providers Oklahoma, which represents a portion of the state’s nearly 300 nursing homes, told StateImpact Oklahoma: “Out of nowhere, the long-term care sector is going to have to find 700-750 new RNs to meet the staffing mandate, and we’re gonna have to ask those new RNs to consider working in the most rural parts of Oklahoma because this is a one-size-fits-all.”

As we said, no one is against the best care possible for clients of these facilities.

But, one-size-fits-all plans generally don’t work. Rural areas will have a hard time attracting the people this federal mandate would require. And, if the facilities can’t meet the mandate and have to close, what happens to the residents? What good are the new rules then?

We would hope federal officials take another look at this mandate, particularly with respect to how it would impact rural areas.

We need a solution that will work in rural Oklahoma.

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