Opinion: Biden mandates the impossible, instead of a solution for long-term care access

A new jobs report released by the federal Bureau of Labor Statistics last month shows that, nationally, 244,600 nursing home jobs were lost during the pandemic and that only 55,100 of those jobs have been recovered since. This means that nursing homes have lost 189,500 workers, or 12% of their workforce.

While the rest of the nation declared the public health emergency over this spring, long-term care providers continue to grapple with a workforce crisis exacerbated by the pandemic. Instead of helping to address a historic and devastating direct care worker shortage that is impeding access to care across the country, the Biden administration has proposed an inoperable and unfunded federal staffing mandate for nursing homes that will only worsen the crisis and threaten the very foundation of our long-term care system.

Iowa nursing homes lost thousands of workers during the pandemic, and today, the sector still has 10% less workforce than pre-pandemic. Finding staff to fill open positions has been excruciatingly difficult, especially in rural Iowa where there is a dwindling population of potential workers and a growing population of seniors in need of long-term care.

ANOTHER VIEW: The crisis in nursing home care is becoming a catastrophe

Because of staffing shortages, 74% of Iowa long-term care providers limited or stopped taking admissions in 2022, according to an Iowa Health Care Association survey. Twenty-three Iowa nursing homes have closed since 2022, primarily due to a lack of staff. This is the largest number of nursing home closures in the state in a single year, and this means there are now 1,371 fewer nursing home beds for patients in Iowa communities.

Iowa long-term care providers continue to make efforts to fill the staffing gaps. The Iowa Health Care Association survey shows 95% have instituted pay increases, 93% have implemented bonuses, 86% have instituted shift differential pay and 83% have offered sign-on bonuses to address staffing challenges. Ninety-one percent have had to ask staff to work overtime or take extra shifts, and 92% say that burnout and stress have been contributing factors to workers leaving. At least 50% of providers are paying additional fees to utilize staffing agencies to fill workforce gaps, though that number is declining thanks to common sense legislation passed by the Iowa Legislature in 2022 to create standards for previously unregulated health care staffing agencies.

Now, Iowa long-term care providers are faced with an inoperable federal minimum staffing mandate in the midst of an historic workforce shortage. If this unfunded mandate is implemented as proposed by the Biden administration, 302 Iowa nursing homes would be required to hire an additional 2,115 workers, whether those workers exist or not, or face closure for non-compliance — at a total cost of more than $100 million a year.

Biden’s mandate demonstrates a shocking lack of awareness about what is actually happening in long-term care in this country. Every single long-term care provider in Iowa would hire more staff today if the staff were available. The administration is mandating the impossible without offering any resources to recruit and retain more staff needed to maintain access to care. This proposed staffing mandate would punish Iowa’s rural providers who cannot meet arbitrary staffing ratios due to a lack of available workers in their communities without additional resources to help.

We are fortunate to live in Iowa, where our governor and state Legislature support long-term care and building a stronger workforce. Both the governor and state Legislature have a strong history of making long-term care residents and workers a priority; they have consistently demonstrated an approach to state policy that is helpful to ensuring access to long-term care for Iowa’s seniors.

During the 2023 legislative session, they approved desperately needed new Medicaid dollars for Iowans who need long-term care, along with other important policy improvements such as change of ownership improvements, certificate of need bed formula updates, tort reform and support for Home- and Community-Based Services, to make a meaningful difference in providing Iowans with a robust continuum of health care services.

Now, the Biden administration’s staffing mandate proposal threatens to unwind the state’s hard work. We need our nation’s leaders to take note from our state’s leaders on how to take innovative and meaningful actions that support health care access and not unfunded mandates that cause more harm.

A good place to start would be to remove roadblocks for those who want to work in long-term care. Instead of an inoperable, unfunded and illogical mandate, let’s offer tax credits, affordable housing alternatives, child care assistance and immigration reform for our long-term care workers.

It’s time to demand our leaders in the White House and on Capitol Hill work to provide comprehensive and innovative solutions that help grow and develop our health care workforce so that we can continue to provide our citizens with the long-term care support they deserve, not mandate the impossible for cheap political points.

Brent Willett is president and CEO of the Iowa Health Care Association and its affiliates and divisions, the Iowa Center for Assisted Living, Iowa Center for Home Care, Iowa Center for Post-Acute and Long-Term Care, IHCA Provider Solutions and the Iowa Health Care Foundation, serve the long-term services and supports profession as a nonprofit trade association. Willett can be reached at brent@iowahealthcare.org.

IHCA’s more than 1,000 member organizations span the continuum of long-term services and supports health care in Iowa.

This article originally appeared on Des Moines Register: Opinion: Joe Biden mandates the impossible for long-term care