More than two weeks after its debut, a proposed staffing mandate for the nation’s 15,000 nursing homes seems to be all skilled nursing operators can talk about.
And why not?
The rule has the potential to change nearly everything about the skilled nursing workforce, from the total time direct care staff spend with patients to the oversight and hands-on care provided by a lot more registered nurses.
But there may be no one as worried as the thousands of licensed practical nurses who currently provide critical services in skilled nursing.
According to the Bureau of Labor Statistics, 35% of the 655,000 LPN roles in the US last year were in nursing and residential care facilities. Of those, only about 56,000 are working in assisted living or similar facilities.
So that leaves about 175,000 LPNs in nursing homes — critical staff members who might no longer fit into the SNF job market if the proposed rule is finalized as currently written.
As provider organizations decry the shift, the Centers for Medicare & Medicaid Services contends the rule’s lack of accounting for hands-on time provided by LPNs is anything but an oversight. LPNs, according to one CMS staffer, simply weren’t associated with enough quality and safety improvements to make the cut.
Adam Richards, deputy director of the CMS Clinical Standards Group, said that was the interpretation the agency came up with after examining the evidence gathered for its nursing home staffing study.
And, wow, what a message that sends to the thousands of women and men who hold these jobs now. These are the same men and women who walk the halls of most nursing homes daily, handling delicate patient care tasks, meeting with families and overseeing the nurse aides on their shifts.
They are licensed to do nearly everything a registered nurse can do — with the exception of admissions assessments, IVs and some other limited treatments — and yet, there’s not enough evidence tying them to patient outcomes to count them in staffing equations?
But wait, CMS, says: They can still stay!
“We believe all staff, including LPNs, are vitally important to the care that residents receive on a daily basis, and we expect long-term care facilities to continue considering all staff when determining staffing and resource needs based on the facility assessment,” Richards told a nursing home stakeholder call last week.
Sure they can stay, but who would want to after that kind of disparagement? LPNs could rightly view this CMS interpretation as a slap in the face, and many may already be looking for new healthcare employers, given the writing on the wall.
Besides, how can skilled nursing facilities be expected to continue paying for LPNs who won’t help them comply with staffing rules, especially if they also will have to hire a bunch of RNs at even higher rates?
To the thousands of LPNs doing the difficult work of patient care, this is a blatantly disrespectful move on the part of CMS. Ultimately, it’s one that could take thousands of loyal and dedicated healthcare workers away from the very patients who need them most.
Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
