Nursing homes in states with significant rural populations have long faced staffing challenges, and the new federal staffing mandate exacerbates this issue. For rural providers, particularly in regions like Nebraska, meeting the federal government's staffing requirements seems almost impossible.
The Difficulty of Recruiting Registered Nurses
Rural communities struggle significantly to recruit registered nurses (RNs). Statistics reveal a disheartening outlook for facilities like Nebraska to comply with the staffing rule's exemptions. Many providers prefer a staffing model tailored to their unique regional needs, but the federal mandate imposes a one-size-fits-all solution.
Jalene Carpenter's Perspective
Jalene Carpenter, President and CEO of the Nebraska Health Care Association, highlighted the impracticality of the 24/7 RN staffing requirement for Nebraska, where many facilities are rural.
"Having a 24/7 RN requirement is not feasible," Carpenter told Skilled Nursing News.
Carpenter emphasized that current state regulations allow facilities to staff according to residents' unique needs, which she believes provides better care than a uniform mandate. She criticized the inflexible federal rule for not considering the diverse needs of different facilities and residents.
"I would also say Nebraska had what we felt was a perfect model, where the regulations are very clear: your staff should meet the residents' needs, and every facility was unique," she said. "So, having this one-size-fits-all approach is not something we support, and we believe it is not best for the residents or the providers."
Challenges in the Northeast Rural Nursing Homes
Rural communities in the Northeast face similar struggles. Brendan Williams, President and CEO of the New Hampshire Health Care Association, noted that most nursing homes in New Hampshire are rural and will find it challenging to meet the federal staffing mandate.
"We cannot afford to have the federal government erase the small progress we have made at the state level," Williams said in a press release.
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) analysis found that the unfunded federal mandate would cost New Hampshire nursing homes $30.4 million annually.
The Grim Reality of Exemption Waivers
Carpenter revealed that despite hopes for exemption waivers, the criteria make it unlikely for any Nebraska facility to qualify.
"Based upon our national affiliates' analysis, there is no single facility in Nebraska that would be eligible for the waiver," she said.
With 95% of facilities not meeting the 24/7 RN requirement and some counties needing more RNs, the mandate appears unattainable under the state's workforce shortage.
Recruitment and Retention Efforts
Efforts to recruit and retain nurses include increasing scholarship funds and collaborating with immigration and refugee organizations. However, these long-term solutions need to address the immediate crisis.
Legislative and Legal Actions
Carpenter highlighted legislative efforts to block the staffing mandate. Senator Deb Fischer and other federal delegates from Nebraska have introduced legislation to counteract the mandate.
"We are very supportive of the fact that our federal delegation and our governor's office have been incredibly supportive. We continue to appreciate that support because this mandate would be a huge burden. Not just when it comes to the facility level of finding staff and paying staff, but there's also going to be a fiscal burden for the state of Nebraska to be able to pay for this increase."
On a national level, the AHCA and several Texas-based providers have filed a lawsuit against federal agencies, aiming to dismiss the staffing mandate. Legal experts believe the lawsuit has a strong chance of success.
Local Success Stories
Despite challenges, some rural nursing home facilities are finding ways to succeed. Burwell Community Memorial Health Center in Nebraska managed a turnaround by focusing on local services, strong management, and staff well-being. Administrator Tim Groshans attributed their success to the not-for-profit model, competitive salaries, benefits, and facility improvements.
The University of Nebraska Medical Center (UNMC) is also building a new healthcare education facility to train more nurses and healthcare workers, particularly in rural areas.
"I can't stress enough how committed our facilities are to quality," Carpenter said. "And we believe that following an individualized approach where every facility staff meets the residents' needs is a much better approach than this. So, I can't stress enough that they have their commitment to quality. This, unfortunately, is not a path to quality for our state. It is an immediate path to closure."
Preparing for the Mandate
Meagan English, Chief People Officer at Oregon-based Marquis Companies, suggested that rural facilities prepare for the mandate by closely monitoring timelines, requirements, and community assessments to understand qualifications for waivers and grants.
"I think for rural communities, it is going to be harder and trickier," she said. "There is a real risk for all our communities, especially rural ones. So, figuring out right now what you can be doing, who you have in your midst to grow, and what resources might be available is hard."
Sally Cantwell, Senior VP of Organizational Development at Utah-based PACS, recommended turning CNAs into nurses through partnerships and transparent career pathways.
"Identify your needs in space," she said. "What are they? Where are your strengths? Can you grow from within? Can you get CNAs more simply than you can nurses? So, turn your CNAs into your nurses with those partnerships that are so valuable."
Conclusion
Nursing homes in rural communities need to meet federal staffing mandates. While tailored staffing models and local recruitment efforts offer some relief, additional legislative, legal, and educational initiatives are essential to address these facilities' immediate and long-term needs. Rural nursing homes can work towards sustainable solutions, prioritizing resident care and facility viability by leveraging local resources, advocating for flexible regulations, and investing in training programs.
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