There is a very real crisis in the world of long-term care, especially in rural settings. However, new federal regulations are being described by some critics as an “unfunded mandate.”
New mandates from the federal government require enough staff to give each resident a minimum of three-and-a-half hours of care daily with at least one registered nurse in a facility 24/7.
Further, all facilities must perform a new facility assessment, regardless of any prior assessments.
Tammy Hatting is the chief operating officer of the South Dakota Association of Healthcare Organizations. She told the legislature's interim appropriations committee this week those goals simply aren’t possible in this health care environment.
"We did everything in our power with our national association, locally, with everyone we knew, to push back on this mandatory staffing ratio that was just a threat at that point," Hatting said. "We honestly didn’t think that they would follow through with their proposed rule as it was written because we all know that RNs and CNAs are hard to find today.”
The shortage of qualified staff was compounded by the COVID-19 pandemic, during which burnout caused an exodus from the health care field – particularly among nurses.
“We all know that patient care and safety in nursing homes is number one, everybody agrees with that, but the way we go about that is not a one-size-fits-all staffing ratio," Hatting said. "In fact, it went to the Office of Management and Budget, back to the Center for Medicare and Medicaid Services and they issued the final rule April 22 of this year – and they actually made it worse, believe it or not.”
Hatting described the current situation as “disaster preparedness” as the clock ticks on getting all the states nursing facilities in line with new requirements.
“You might say, 'Well, some of these nursing homes won’t be able to do this at all,'" Hatting said. "'Is there a way they can apply for a hardship? Is there an exemption or some sort of waiver?' The answer is yes, but it is a checklist that is huge with all kinds of exemption criteria, exclusions and notifications have to be posted. It really becomes unattainable. We don’t even think it’s possible for some of our facilities in South Dakota to be able to apply for this hardship.”
These new regulations must be adhered to by May 2026 for urban facilities, and 2027 in rural settings before facing penalties.