Published in RINewsToday on May 13, 2024
By Herb Weiss
The recently released 2024 Social Security and Medicare Trustees report shows an improved outlook for these programs. This year’s projections show that Social Security can pay its benefits and cover administrative costs now until 2035, one year longer than projected in last year’s report. But, after that, it can only cover 83 percent of benefits, even if Congress fails to take no action to fix the program to ensure its financial viability.
Medicare’s fiscal health improves even more, says the Medicare Trustees Report. It projects that the program’s Part A (Hospital) fund will be able to pay 100% of scheduled benefits until 2036 — a full five years later than estimated by the trustees last year.
Under the Social Security Act of 1935, the Board of Trustees is required to submit the annual reports on the current and projected financial status of the trust funds to Congress on April 1 each year.
It’s Time for Congress to Protect Social Security
“This year’s report is a measure of good news,” says Martin O’Malley, Commissioner of Social Security, in a statement recognizing the impact of “strong economic that have yielded impressive wage growth, historic job creation and a steady, low unemployment rate.”
“So long as Americans across our country continue to work, Social Security can — and will — continue to pay benefits,” says O’Malley, calling on Congress to take action to ensure the financial viability of the Trust Fund “into the foreseeable future just as it did I the past on a bipartisan basis.”
“I will continue to urge Congress to protect and support Social Security and restore the growth of the funds. Whether Congress chooses to eliminate the shortfall by increasing revenue, reducing benefits, or some combination, is a matter of political preference, not affordability,” observes O’Malley, noting that there are several legislative proposals that address the shortfall without benefit cuts — it should debate and vote on these and any other proposals.
Social Security Advocacy Groups. Key GOP Lawmaker Issue Statements
With the May 6 release of the 2024 Social Security and Medicare Trustees report, statements were generated by Social Security advocacy groups and Congressional lawmakers to give their take on the projections.
Even with the report pushing back the expected depletion dates for Social Security and Medicare, Max Richtman, President & CEO, National Committee to Preserve Social Security & Medicare (NCPSSM) called for Congress to immediately act to strengthen the Social Security program for the 67 million beneficiaries. “We cannot afford to wait to take action until the trust fund is mere months from insolvency, as Congress did in 1983. The sooner Congress acts, the less painful the remedies will be, says Richtman.
In responding to comments that Social Security is going ‘bankrupt, Richtman says: “Revenue always will flow into Social Security from workers’ payroll contributions, so the program will never be ‘broke.’ But no one wants seniors to suffer an automatic 17% benefit cut in 2035, so Congress must act deliberately, but not recklessly. A bad deal driven by cuts to earned benefits could be worse than no deal at all.”
Richtman warns that seniors will take a devastating financial hit if Congress is forced to make cuts in 2035. “Average Social Security benefits are already very modest — about $23,000 per year, which is only $3,000 higher than the federal poverty line for a household of two,” he says, noting that wealthier beneficiaries can afford to contribute more to the program without hurting them financially.
“Social Security has an accumulated surplus of $2.79 trillion. It is 90 percent funded for the next quarter century, 83 percent for the next half century, and 81 percent for the next three quarters of a century. At the end of the century, in 2100,” says Nancy Altman, President of Social Security Works, noting that the program is projected to cost just 6.1 percent of gross domestic product (“GDP”).
Like the SSA Commissioner and NCPSSM’s Richtman, and Altman urges Congress to act sooner rather than later to ensure that Social Security can pay full benefits for generations to come, along with expanding Social Security’s modest benefits. “That will restore one of the most important benefits Social Security is intended to provide to the American people — a sense of security,” she says.
As to Medicare, the released report notes the life expectancy for Medicare part A Trust Fund is extended another five years.
“It’s great news that the Part A trust fund has an additional FIVE years before it becomes depleted, partly because of the unexpected strength of the U.S. economy. But current and future seniors expect action to keep the trust fund solvent for the long-term,” said Richtman.
“We support President Biden’s plan to strengthen Medicare’s finances, as laid out in his FY 2024 and 2025 budgets,” says Richtman, noting that the president’s plan would bring more revenue into the program, rather than cutting benefits as some Republicans have proposed. “Building on the prescription drug pricing reforms in the Inflation Reduction Act, the President’s budget proposal would lower Medicare’s costs — and some of those savings would be used to extend the solvency of the Part A trust fund,” he says.
According to Richtman, beyond trust fund solvency, the Trustees reported that the standard Medicare Part B premium will rise next year to $185 per month – a $20 or 6 percent monthly increase. “Any premium increase is a burden to seniors living on fixed incomes, who too often must choose between paying monthly bills or filling prescriptions and getting proper health care. Seniors need relief from rising premiums and skyrocketing out-of-pocket health care costs. Fortunately, the Biden administration is taking steps to reduce those costs,” said Richtman.
Key GOP Chair Responds to Trustee Reports
Chairman Jodey Arrington (R-TX), of the House Budget Committee, quickly released a statement, responding to the release of the 2024 Social Security and Medicare Trustees report.
According to Arrington, the House Budget Committee’s Fiscal Year (FY) 2025 Budget, while not making any changes to Social Security or Medicare benefits, provides a way to prod Congress and the President to address the fiscal insolvency of these programs. The Budget Committee has also reported the Fiscal Commission Act, which will also give Congress the tools it needs to save and strengthen these vital programs,” he noted.
“We have the highest levels of indebtedness in our nation’s history, an inflationary and anemic economy, and the two most important senior safety net programs facing insolvency, says Arrington, noting that this year’s trustees report “only reiterates why we need a bipartisan Fiscal Commission to address the Social Security and Medicare Trust Funds and the $140 trillion unfunded liability on America’s balance sheet.”
“Republicans and Democrats have both proven they will not fix Social Security and Medicare on their own. We must put our seniors and country first and work together to find a solution,” he charges. “Doing nothing is condemning our seniors to automatic benefit cuts and our country to a future debt crisis,” he says.
Fixing Social Security…A Difference in Perspective.
Both NCPSSM and Social Security Works strongly endorse financially shoring up Social Security by bringing in more money into the trust fund by increasing the payroll wage-cap to require higher-income beneficiaries to pay a higher Social Security payroll tax. Both Social Security advocacy groups endorse Rep. John Larson’s (D-CT) Social Security 2100 Act, a legislative proposal would maintain the current payroll wage cap (currently set at $168,600), but subjecting wages $400,000 and above to payroll taxes, as well — and dedicating some of high-earners’ investment income to Social Security.
On the other hand, Republican lawmakers call for cutting earned benefits of younger workers by raising the full-retirement age, means-testing, and replacing the exiting COLA (CPI-W with the Chained CPI-U) that would result in a lower COLA over time. Also, no COLA’s would be provided to high income earners.
Social Security is considered the third rail a nation’s politics. Political pundits say that contact with the rail is like touching this high-voltage rail that can result in “political suicide.” That is why the GOP-controlled House Budget Committee has proposed to create a fiscal commission to give lawmakers political cover to enact the cuts without having to vote on the record.
Over two months ago, the most recent budget hammered out by the Republican Study Committee, endorsed by 80 percent of the House Republicans, calls for over $1.5 trillion in cuts to Social Security in just the next ten years., including an increase in the retirement age to 69 and cutting disability benefits Medicare costs for seniors by taking away Medicare’s authority to negotiate drug costs, repealing a $ 35 insulin, and $ 2,000 out-of-pocket cap in the Inflation Reduction Act.
Additionally, the House GOP budget transitions Medicare to a premium support system that the Congressional Budget Office has found would raises premiums for many seniors. Finally, it calls for cuts in Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program by $ 4.5 trillion over ten years, taking health care coverage away from millions of people.
While President Donald Trump, the GOP’s presidential candidate, has previous said he wouldn’t make cuts to Social Security, recent interviews reveal a change. According to a March 11, 2024 web posting by CNN’s Kate Sullivan and Tami Luhby, former President Donald Trump, the Republican candidate for president, “suggested[ in a CNBC interview] he was open to making cuts to Social Security and Medicare after opposing touching the entitlement programs and attacking his GOP presidential primary rivals over the issue.”
At the Polls
Legislative proposals to fix the ailing Social Security and Medicare programs are different as night and day. Rather than to continue to debate the fine points, let’s put the differing policies on the ballot. With just 177 days left before the upcoming November presidential election, Congress must vote on Democratic and Republican legislative proposals, detailing differing provisions as to how these programs can increase the financial stability of these programs. Larson has already thrown his legislative proposal into the hopper, but it won’t see the light of day with a GOP controlled House.
Last year, 66 million Americans received Social Security benefits. This year’s Trustee’s report must send a clear message to these beneficiaries that how Congress acts during the next decade will either make or break the Social Security program.
So, now House Speaker Mike Johnson, (R-La) and Senate President Charles E. Schumer (D- NY) must allow a vote on both Republican and Democratic legislative proposals in their respective chambers. Let Senate and House lawmakers go on the record and publicly be tied to a vote as to which legislative political strategy they endorse to financially shore up Social Security and Medicare. Of course, this can give voters a score card. And if this political issue is as important to them as the economy, abortion, and immigration, they can decide at the ballot box who they should bring back to Capitol Hill.
That’s the American way to do it.
Bipartisan support needed to re-establish House Aging Committee
Published in RINewsToday on May 6, 2024
It was almost like attending a 34th high school reunion. After over three decades, an on-line meeting on April 25th, would bring five former senior staffers of the House Select Committee on Aging (HSCoA) and House Rules Committee back together to provide firsthand accounts to Maia Leeds, legislative assistant for Josh Gottheimer (D-NJ), as to why the New Jersey Congressman, co-chair of the bipartisan House Problem Solvers Caucus, should call on the caucus to endorse H. Res. 1029, re-establishing the House Select Committee on Aging.
Washington, DC-based groups, including the National Committee to Preserve Social Security and Medicare (NCPSSM), Social Security Works and the Alliance for Retired Americans, including this writer, along with key staff of Congressman Seth Magaziner (D-RI), the primary sponsor of the resolution, participated in the discussion of how the Rhode Island Congressman could attract more cosponsors, especially House Republican lawmakers.
Throughout the half-hour meeting, Leeds and others stressed the importance of recruiting Republican lawmakers, calling for bipartisan support of H. Res. 1029. According to “Votes in Congress” published in the New York Times on Oct. 13, 1974, even with the Democrats controlling the House in 1974, the HSCoA was established by a huge bipartisan vote of 299 to 74. In 1993, House Democratic belt-tightening efforts to save $ 1.5 million funding the operations of HSCoA would force it to close its door.
The House Aging Committee was not charged with drafting legislation. Its mission was to conduct investigations and hold hearings to put the spotlight on aging issues that would ultimately lead standing committees with aging jurisdiction to craft legislation to address these issues.
From the 114th Congress, until he retired during the 117th Congress, in each Congressional session, former Congressman David Cicilline had introduced a resolution to bring back the HSCoA. The resolution failed to gain traction and get support from either House Republic Leader Paul Ryan or House Democratic Leader Nancy Pelosi. Magaziner would ultimately pick up the baton and introduce H. Res. 1029, on Feb. 23, 2024. This resolution was referred to the House Committee on Rules for mark-up, and if passed will be considered by the full House. At press time, there are only 26 Democratic cosponsors, with no Republican cosponsors.
Simply Put…
Magaziner’s 213-word resolution simply amends the Rules of the House to establish a HSCoA, without legislative jurisdiction, to conduct a continuing comprehensive study and review an array of aging issues, including income maintenance, poverty, housing, health (including medical research), welfare, employment, education, and long-term care.
H. Res. 1029 also calls for the reestablished HSCoA to study ways that would encourage the development of public and private sector programs and policies that would keep older Americans active in their community.
The resolution would also allow the HSCoA to develop policies that would encourage the coordination of both government and private programs designed to deal with problems of aging -and to review any recommendations made by the President or White House Conference on Aging in relations to programs and policies impacting seniors.
According to EveryCRS Report, the House can easily establish an ad hoc (temporary) select committee just by approving a simple resolution with no Senate or Presidential approval. It contains language establishing the committee, detailing a purpose, defining membership. Salaries and expenses of standing committees, special and select, are authorized through the Legislative Branch Appropriations bill.
Magaziner, currently out on parental leave, couldn’t make the online meeting, but Chief of Staff Clayton Schroers, and Kyra Whitelaw, Legislative Assistant, came to monitor the gathering to gain insight from former staffers of HSCoA’s impact on the development of aging policy.
According to Magaziner, his staff are working hard to speak to other congressional offices about the benefits of the proposed committee and who will continue to work to raise the profile of this resolution to encourage other members to become cosponsors. “I was grateful for the opportunity to present to the Leadership Council on Aging, a national coalition of national nonprofit organizations that works on policy issues related to the well-being of America’s seniors,” says Magaziner, noting that his resolution has the support of the NCPSSM and Meals on Wheels America.”
As Magaziner works to increase the number of cosponsors for H. Res. 1029, he says: “The support of advocates is important to encouraging Congressional representatives to cosponsor this resolution.”
“I’m ready to work with anyone, from either party, to deliver results for Rhode Island—and that includes finding common ground on important legislation like H. Res. 1029,” says Magaziner. “I believe there’s still room for bipartisanship, and ensuring we address issues for seniors across the country should be an area where we can all agree. I will continue to urge my Republican colleagues to work together with Democrats to move our country forward,” he says.
Former Congressional staffers call for passage of H. Res. 1029
“A House Aging Committee would centralize Congress’s consideration of older American issues and could be of assistance to authorizing committees with legislative jurisdiction over agencies and programs important to seniors,” says Max Richtman, NCPSSM’s President and CEO, explaining why NCPSSM will directly encourage House members to cosponsor H. Res. 1029.
According to Richtman, a 16-year veteran of Capitol Hill, the pros outweigh the cons on supporting Magaziner’s resolution. A House Aging Committee would centralize Congress’s consideration of older American issues and could be of assistance to authorizing committees with legislative jurisdiction over agencies and programs important to seniors. However, it would take staff and clerk hire (money) away from the authorizing committees.
Like Magaziner, Richtman observes that bipartisan support for programs and agencies important to senior has a mixed record. “There is some bipartisan agreement on the Older Americans Act (OAA). But even on OAA, bipartisan action can vary widely, says Richtman, especially when Republicans want to make across the board cuts to non-defense discretionary spending, including OAA, Supplemental Nutrition Assistance Program and Low-Income Home Energy Assistance Program. “And there appears to be no bipartisan agreement on Social Security, Medicare and Medicaid,” he says.
Richtman, a former Staff Director of the Senate Special Committee on Aging, says that the upper chamber sees the value of the Senate Aging Committee, noting that he believes that it has operated in a bipartisan manner.
Bob Blancato, former Executive Director of the 1995 White House Conference on Aging and former Staff Director, Subcommittee on Housing & Consumer Interests, from 1978-93, has joined the efforts to pass H. Res. 1029. “I just wanted to add another voice in favor of this resolution,” says Blancato, President of Matz, Blancato and Associates.
According to Blancato, who served as Staff Director of the Subcommittee on Human Services from 1977 to 1991, important policies were addressed over those years. Several amendments to the Older Americans Act were adopting, including creating a separate program for home delivered meals. He remembers his subcommittee held the first hearing ever on the issue of grandparent visitation rights.
Although some standing committee chairs felt THE aging committee made them work harder because of issues raised in their legislative jurisdictions, there were many examples of both “working together,” says Blancato. He recalls the House Education and Labor Committee working close with his subcommittee on legislation, including the Older Americans Act and the Age Discrimination in Employment Act.
Blancato sees the need to bringing back the HSCoA. Since it was abolished over 30 years ago, there are many issues that need to be addressed with the graying of the nation’s population, he says.
“A good gauge to see if House lawmakers consider aging policy to be a bipartisan issue is if the Older Americans Act gets renewed on a bipartisan vote this year,” notes Blancato, stressing that “this will be a good test.”
Elaina K. Goldstein, JD, MPA remembers the day when the HSCoA ceased to exist. “It was heartbreaking to have to pack up the incredible work done by the HSCoA and I am thrilled to be involved with its resurrection,” says the former Legal Counsel for the Subcommittee on Retirement and Employment. “It would be incredible if H. Res. 1029 passes, to once again see its staff work hand in hand with the Committees of jurisdiction to get important issues into the light so they could be remedied to make life better for seniors,” she says.
As a former HSCoA staffer, Goldstein disagrees with those seeing conflict between the Select Committee and Standing Committees. “Quite the opposite,” she said, noting that Subcommittees did not have and will not have any legislative jurisdiction.,” she noted.
According to Goldstein, many of the Employee Retirement Income Security Act of 1974 (ERISA) health concerns and subsequent hearings held by HSCoA were uncovered by the Senate Finance Committee staff who felt they could not move forward politically in their Committee but felt the House Aging Committee could get the issue out in the open and then they could follow up. “As I said, these issues were ultimately addressed in the passage of the Health Insurance Portability and accountability Act of 1996,” she noted.
As to gaining Republican cosponsors, Goldstein sees aging policy losing some of its bi-partisan appeal with the debates over Social Security and Medicare. “It seems that Republican lawmakers feel the issues of Social Security and Medicare are Democratic issues,” she says, noting that there are so many others. “If the Committee would also take on the issues and concerns of people with disabilities —which they do in the Senate Aging committee —many issues that impact the aging are issues for the disabled as well,” she says, stressing this could well increase bi-partisan appeal.
Robert Weiner, President of Robert Weiner Associates News, saw the negative impact of the HSCoA being abolished. As Staff Director of the Health and Long-Term Care Subcommittee from 1975-76 and the former Claude Pepper’s (D-FL) Chief of Staff (1976-80) when he chaired the full committee, Weiner knew how shortchanged seniors would be when the committee was abolished. “I always have wanted that decision reconsidered.,” he said.
“Reform”, instead of facts on Social Security have unfortunately now become the political value system norm, and age discrimination has crept back more and more, from hiring and firing in everything whether private sector or politics. The Aging Committee and its members were and could again be a wedge of power representing older Americans of both parties,” says Weiner, who was a close confident of Pepper until he died in 1989.
Looking back, “We got legislation passed abolishing age-based mandatory retirement, as well as Medicare expansion of home health care, standards for cancer insurance, a major Social Security protection deal co-authored by Pepper, and many other laws by initial press during our investigations and then working closely with the standing committees on the bills,” says Weiner.
Some say that Cicilline’s efforts to pass the resolution to reestablish the HSCoA stalled because of the standing committee’s fear of loss of power in the legislative process. “This is anything but new. We did, and any new committee must, cooperate with, meet with, and support the standing committees’ efforts. Pepper always made friends and cooperated. We worked closely with chairs and leaders from Gus Hawkins (D-CA) to Gladys Spellman (D-MD) to Dan Rostenkoswski (D-Ill) to House Speaker Tip O’Neill (D-Mass) and Republican leader Bob Michel (R-Ill),” remembered Weiner.
The key to getting Magaziner’s resolution passed is for the Congressman to actively work to expand the co-sponsorships by taking co-sponsorship sign-up sheets and have conversations around the House floor and cloakrooms and thereby get to well over 100,” says Weiner.
A Final Note:
At the on-line meeting, former Senior Staff of HSCoA and Washington, DC-based aging groups, and Rhode Island senior advocates, praised Congressman Josh Gottheimer’s co-sponsorship of H. Res. 1029. Increasing the number of co-sponsors to over 100, especially recruiting GOP lawmakers, might just give the resolution traction this Congress. Hopefully, Congressman Brian K. Fitzpatrick (R-PA) and the moderate Democratic and Republican members of his caucus will see the value of following Gottheimer’s lead. Yes, aging should be considered a bipartisan issue, just like it was in 1974 when both Democrats and Republicans rallied to establish HSCoA.
Without support of the House Republican leadership, Richtman warns that it is unlikely that H. Res. 1029 will be considered during the 118th Congress. However, efforts to drive up the number of cosponsors – especially if it can attract some Republican support – might enable the resolution to be considered if there is a more pro-senior majority in the House of Representatives,” he says.
It’s now time for House Speaker Mike Johnson (R-LA) to step to the plate and support H. Res. 1029, and consider aging to be a bipartisan issue. The switching of legislative control in the Senate over 47 years and the contentious debates over Social Security and Medicare, has had little impact on the operations of the Senate Special Committee on Aging. The bipartisan panel has continued to investigate and put the spotlight on critical aging issues, working with Senate standing committees to draft legislation to enhance the life and well-being of America’s seniors. It’s now time for the House to bring back the HSCoA.
Herb Weiss, LRI’12, is a Pawtucket-based writer who has covered aging, health care and medical issues for over 44 years. To purchase his books, Taking Charge: Collected Stories on Aging Boldly, and a sequel, compiling weekly articles published in this commentary, go to herbweiss.com.
Participants of April 25 online meeting:
House Staffers: Chief of Staff Clayton Schroers and Kyra Whitelaw, Legislative Assistant, Office of Congressman Seth Magaziner; Maia Leeds, legislative Assistant, for Josh Gottheimer, Office of Congressman Josh Gottheimer.
Senior House Staffers: Bill Benson, former Assistant Secretary for Aging, US Dept. of Health and Human Services and former Staff Director of the Subcommittee on Housing & Consumer Interests, House Permanent Select Committee on Aging, from 1987-90; Bob Blancato, former Executive Director of the 1995 White House Conference on Aging and former Staff Director, Subcommittee on Housing & Consumer Interests, from 1978-93; Elaina K. Goldstein, JD, MPA, former Legal Counsel for the Subcommittee on Retirement Income and Employment; Robert S. Weiner, former Staff Director, Subcommittee on Health and Long-Term Care from 1975-77, Chief of Staff of the full Aging Committee from 1976-80); Thomas J. Spulak, former Staff Director, House Rules Committee (under Congressman Pepper), 1982-89 and Chair, the Claude Pepper Foundation.
National Aging Organizations: Nancy Altman, President, Social Security Works, Dan Adcock, Government Relations and Policy Director of the NCPSSM; and David Simon, Legislative Representative for the Alliance for Retired Americans.
Rhode Island: Vincent Marzullo, former Director of the Corporation for National Community Service, Board member of the Senior Agenda of RI, and member of Magaziner’s Senior Advisory Council; Robert Robillard, President of RI Senior Center Directors Association; and writer Herb Weiss.
Advocates, providers on new Nursing Home mandates
Published in RINewsToday on April 29, 2024
In the shadow of Rhode Island’s ongoing staffing shortage, the Center for Medicare and Medicaid Services (CMS) issued its 329-page final rule on Nursing Home Minimum Staffing Standards (CMS 3442-F) on April 22 in the Federal Rule.
CMS affirmed its commitment to hold nursing homes accountable for providing safe and high-quality care for the nearly 1.2 million residents living in Medicare-and Medicaid-certified long-term care facilities.
According to CMS, over 46,000 public comments submitted in response to the proposed rule. Central to this final rule are new comprehensive minimum nurse staffing requirements, which aim to significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes.
Just the Nuts and Bolts
CMS say that central to its final rule are new comprehensive minimum nurse staffing requirements that would significantly reduce the risk of residents receiving unsafe and low-quality care within nursing homes. The agency is finalizing a total nurse staffing standard of 3.48 hours per resident day (HPRD), which must include at least 0.55 HPRD of direct registered nurse (RN) care and 2.45 HPRD of direct nurse aide care. Facilities are given the flexibility to use any combination of nurse staff (RN, licensed practical nurse [LPN] and licensed vocational nurse [LVN], or nurse aide) to account for the additional 0.48 HPRD needed to comply with the total nurse staffing standard.
CMS is also finalizing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care.
This final rule provides a staggered implementation timeframe for facilities to meet the minimum nurse staffing standards and 24/7 RN requirement based on geographic location as well as possible exemptions for qualifying facilities for some parts of these requirements based on workforce unavailability and other factors. The requirements of this final rule prioritize safety and health care quality while taking into consideration the unique workforce challenges some nursing homes are facing, especially those operating in rural areas.
CMS will closely monitor and evaluate the provisions of this final rule, including but not limited to, the minimum staffing standards, the 24/7 RN requirement, the exemption process, and the definition of rural, as they are implemented over the next several years to determine whether any updates or changes are necessary in the future.
Additionally, to increase transparency related to compensation for workers, CMS will also require states to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities.
Provider, advocate positions on new CMS final rule
At press time, the RI Department of Health (RIDOH) had no comments about CMS’s new final rule released last week, say Joseph Wendelken, RIDOH’s public information officer. The state agency is reviewing the rule and assessing its impact and applicability in Rhode Island,” he says.
With the final rules release, senior advocates and providers are expressing their opinion about its impact.
Former President Donald Trump, who is challenging President Joe Biden for the presidency, has not addressed quality of care in nursing homes with a formal position. Kathleen Heren, Rhode Island’s Ombudsman, speculates that by releasing the CMS mandate before the upcoming presidential election, President Biden is just trying “to establish a record” of enhancing quality of care in nursing homes.
“Nursing homes cannot find Registered nurses (RN), and Nursing Assistances to hire,” notes Heren. The CMS mandate will force nursing homes to downsize, like we have just seen happen at the Scandinavian Home,” she predicts.
According to Heren, the final CMS rules do not include the minimum staffing of LPNs. More important, “it’s an unfunded mandate,” she says.
Gerontologist Deb Burton, MS, executive director of RI Elder Info, is pleased to see a Federal minimum staffing mandate of 3.48 hours of daily nursing care. “It’s important to understand mandates don’t make workers appear and a minimum staffing mandate is only an average amount of time allotted for care across all residents in the facility,” she says, noting that this rule doesn’t mean each resident will receive 3.48 hours of care each day.
According to Burton, the CMS Nursing Home Compare website, as of April 2024, notes there are 6 Rhode Island facilities that would not meet the lower federal minimum staffing mandate if it were enacted today. “The workforce shortage and the dire need to increase Medicaid reimbursements to attract and retain adequate staff with a proper wage are common topics of meetings,” says Burton.
“When workers say ‘It’s only me on the floor – do I help the resident eat their supper or take the other resident to the bathroom? I can’t do both,’ – we need to listen,” says Burton. “The new federal minimum staffing mandate is a good step forward, but we need more. One day it will likely be us waiting for that workers’ help,” she warns.
Like other RI senior advocates, Maureen Maigret, policy director for the Senior Agenda Coalition of RI, sees the importance of CMS releasing its final rules. “It is important that these regulations have been finalized as providing for minimum nurse staffing levels in nursing homes helps ensure residents across the country will receive quality and resident-centered care,” she says.
According to Maigret, Rhode Island has had a provision for 24/7 RN coverage even before the state’s minimum staffing law was passed so that is not a new requirement here. She pointed out the regulations will also promote transparency and accountability by requiring public reporting on how much of the Medicaid payments are spent on direct care staff and that the federal government has committed to invest over $75 Million in an initiative to increase the number of nurses working in nursing homes through such things as financial incentives for tuition reimbursement.
“We are dismayed that the Biden Administration is moving forward with this one-size-fits-all staffing mandate,” says John E. Gage, President and CEO of the Rhode Island Health Care Association. “In the midst of a historic and deepening caregiver shortage, this unrealistic policy will put access to care at risk for countless seniors in Rhode Island and across the country,” he warns, noting that when nursing homes can’t find nurses and/or certified nursing assistants (CNAs), they will be forced to downsize or, even worse, close their doors altogether, leaving seniors with fewer options to receive the care they need.
New final rule just another unfunded mandate
Like the 2021 RI staffing law, the Federal rule is an unfunded mandate, charges Gage. “Every nursing home wants more workers, but rather than blanket mandates from Washington, we need supportive policies and investments that will help us recruit and retain caregivers, he states.
According to Gage, nationally, the nursing home workforce has declined by 124,200 individuals (-7.8%) since the start of the pandemic. Rhode Island’s numbers are even worse, down 1,495 individuals (-15.3%). Gage calls on Congress to step up and support the bipartisan Protecting America’s Seniors’ Access to Care Act, which would prevent CMS from enforcing this unfunded and flawed mandate.
“Together with our national association, the American Health Care Association (AHCA), we will continue to fight for more common-sense solutions and do everything we can to preserve access to care for Rhode Island seniors,” says Gage.
“The good news about the Biden Administration’s final rule, there are phase-ins over multiple years that will provide an opportunity to challenge the mandates through legislation and/or possible AHCA litigation on the national level,” adds Gage. “The federal mandate highlights how much of an outlier RI’s staffing mandate is. The RI statute has the highest staffing metrics and the highest fines in the country – 10% above the federal standards. Without the Executive Actions of Governor McKee, RI nursing homes would be fined $90 million in the first full year of enforcement – devastating facilities and forcing further closures. RI excludes hours worked by administrative nurses from counting toward the RN metric, yet they are included in the federal standards. RI also excludes med techs’ and nurse aides in training’s hours from the CNA metric, while CMS includes them,” noted Gage.
Gage adds that the CMS final rules consider Rhode Island to be “urban.” As a result, the state has 2 years to phase-in the 24×7 RN requirement.
Rhode Island regulations and law have required 24×7 RN coverage in nursing homes for many decades, says Gage. “While challenging to maintain compliance given the shortage of registered nurses, this should not be a major concern for RI facilities,” he adds, noting that there will be 3 years to comply with the required 0.55 HPRD for RNs and 2.45 HPRD for CNAs.
Additionally, Gage says that there are also waiver opportunities in certain circumstances. “During the implementation phase, facilities and all stakeholders must be laser-focused on building a sufficient pipeline of qualified nurses and CNAs to the nursing home workforce,” he says.
Like Gage, James Nyberg, executive director LeadingAgeRI, sees the CMS mandate as less onerous than the RI staffing mandate that “fortunately” remains suspended. “We remain concerned about the impact of this national mandate on providers in Rhode Island, and its broader impact on consumers and the health care industry,” he says.
According to Nyberg, the state’s current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (six nursing homes have already closed since the COVID pandemic began and two more have embarked on significant downsizing).
“These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes,” says Nyberg, noting that LeadingAgeRI is working with numerous stakeholders on various initiatives to develop a pipeline of workers. “But the simple fact is that it will take time and an infusion of resources,” he adds.
“CMS proposes to spend $75 million on a nursing home staffing campaign. That amount might help a state like Rhode Island, but that money is national, so it is a drop in the bucket in terms of the support the industry needs, states Nyberg. “On the home front, we have been working with the Administration and the General Assembly to provide an infusion of funding to try and rescue the homes from their dire financial straits and try to stabilize the industry. But the federal mandate, and all the related details and requirements embedded in the rule, do nothing to further that cause,” he says.
For the Minimum Nursing Standard final rules, go to https://public-inspection.federalregister.gov/2024-08273.pdf
For the CMS Fact Sheet on Minimum Nursing Standard final rules, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0
Herb Weiss 