Tag Archives for Medicaid

Social Security must be key issue in 2024 Presidential Election

Published in RINewsToday on July 17, 2023

Last Wednesday, 178 House Democrats, (90% of the House Democratic caucus) led by Rep. John Larson (D-Conn.) introduced  H.R. 4583, the “Social Security 2100 Act of 2023.” The 108-page bill would expand Social Security’s benefits, with no cuts, and keep the system fiscally strong for decades to come. Senator Richard Blumenthal (D-Connecticut) has introduced the companion measure in the upper Chamber.

In May, to drum up support, enthusiasm, and attention for H.R. 4583, Larson, House Ways and Means Social Security Subcommittee Ranking Member, was joined by House Democratic Leader Hakeem Jeffries (D-,New York), Ways and Means Committee Ranking Member Richard Neal (D- Massachusetts) and other House leaders to announce the upcoming introduction of Social Security 2100.

“10,000 Baby Boomers a day become eligible for Social Security, making the point of acting now even more urgent, says Larson. “I am proud to be joined again by a majority of my Democratic colleagues to introduce Social Security 2100, and again, ask my Republican colleagues, whose legislation we’ve included, to join us in helping uplift the 65 million Americans who rely on it. Including lifting 5 million Americans out of poverty, providing 23 million a tax cut, and making sure that Americans are able to get the essential benefits that allow them to pay rent, buy groceries, and fill their prescriptions,” he says.

“It’s important that the Social Security benefits that working Rhode Islanders have earned keep up with the cost of living, and that’s exactly what H.R.4583 – Social Security 2100 Act will accomplish. Unfortunately, extreme Republicans in the House are trying to cut Social Security instead of strengthening it. But I am determined to fight for Rhode Island’s seniors in Congress to ensure they receive the benefits they’ve earned,” says Congressman Seth Magaziner (D-R.I.), a sponsor of the legislative proposal. 

H.R. 4583: The Nuts and Bolts

On July 12, 2023, H.R. 4583 was introduced and referred to the House Ways and Means, Education and Labor, and Energy and Commerce Committees, being introduced in the lower chamber that day.

According to a legislative fact sheet, H.R. 4583, the legislative proposal would increase and expand essential benefits to Social Security beneficiaries. Larson’s legislation would:

•   Increase benefits 2% across the board for all Social Security beneficiaries for the first time in 52 years.  

• Improve the Cost-of-Living Adjustment (COLA), so it reflects the inflation actually experienced by seniors.

• Increase benefits to boost lower income seniors.

• Improve benefits for middle-income widows and widowers from two-income households.

• Restore student benefits up to age 26, for the dependent children of disabled, deceased, or retired workers.

• Increase access to benefits for children living with grandparents or other relatives.

• Repeal the Windfall Elimination Provision (WEP) and Government Pension Offset (GPO) that currently penalize many public servants.

• End the 5-month waiting period to receive disability benefits.

• Increases benefits by an additional 5% for the most elderly and those who have been receiving disability benefits the longest, those beneficiaries who have been receiving benefits for 15 years or more.

 • Provide caregiver credits to ensure that people (mostly women) are not penalized in retirement for taking time out of the workforce to care for children or other dependents.

• End the disability benefit cliff, replacing it with a gradual offset for earnings.

• Cut taxes for 23 million middle-income beneficiaries.

• Correct an unintended flaw in how Social Security benefits are wage-indexed, to prevent benefits from dropping (a “notch”) if the wage index decreases.

• Ensure that these benefits do not result in reduced Supplemental Security Income (SSI) payments or a loss of eligibility for Medicaid or CHIP.

• Combine the Old-Age and Survivors Insurance (OASI) and the Disability Insurance (DI) Trust Funds into one fund to ensure seamless benefit payments.

• Provide the Social Security Administration with resources to improve customer service.

Social Security 2100 Pays for These Benefits by:

• Ensuring millionaires and billionaires pay their fair share by applying FICA to earnings above $400,000.

H.R. 4583 would pay for strengthening the Social Security Trust Fund and pay for the enhanced benefits by having millionaires and billionaires pay their fair share by applying FICA to earnings above $400,000, with those extra earnings counted toward benefits at a reduced rate. The bill closes the loophole of avoiding FICA taxes and receiving a lower rate on investment income by adding an additional 12.4% net investment income tax (NIIT) only for taxpayers making over $400,000.

Social Security advocates call for passage

“By re-introducing his revised Social Security 2100 Act, Congressman John Larson once again defies the media narrative that ‘no one in Washington has the courage’ to address the program’s future,” says Max Richtman, President and CEO, of the Washington, DC-based National Committee to Preserve Social Security and Medicare, noting that the legislation extends the solvency of the Social Security trust fund for decades while also providing American seniors with an expansion of benefits.  Larson tackles the funding of the expansion of benefits by asking high earners to begin paying their fair share into the program, says Richtman. 

“At a time when House Republicans have proposed cutting benefits by raising the retirement age and other means — Congressman Larson offers a commonsense, fair, and forward-looking plan.

Not only is the Social Security 2100 Act wise policy, but it’s also overwhelmingly popular with voters across the political spectrum,” says Nancy Altman, President of Social Security Works and Chair of the Strengthen Social Security Coalition.

As the debate over Social Security heats up before the 2024 Presidential election, Altman charges that the nation’s media  refuses to “take Democratic plans to protect and expand Social Security seriously, and fails to call out Republicans for their unwillingness to state what they are for, not just what they are against.”

“Reporters are implicitly dismissing these bills because they cannot pass the House and Senate without Republican support. Instead of pressuring Congressional Republicans to introduce their own legislation, the mainstream media provides the Republicans with the cover they seek by claiming that both parties are avoiding action on Social Security” says Altman.

According to Altman, earlier this year President Joe Biden used the presidential bully pulpit at the State of the Union address to call out Republicans for their plans to cut Social Security and Medicare, forcing them to take these program cuts off the table during the debt ceiling negotiations. “If Biden champions a plan that expands benefits with no cuts, while requiring those earning over $400,000 to pay more, the mainstream media will be unable to ignore it,” predicts Altman. 

Congressional strategies regarding Social Security

On the same day that Larson introduced his legislation, Senator Sheldon Whitehouse (D-R.I.), Chairman of the Senate Budget Committee, held a hearing, “Protecting Social Security for All: Making the Wealthy Pay Their Fair Share,”  on his legislation, S. 1174, the Medicare and Social Security Fair Share Act.  A companion measure was introduced in the House by Congressman Brendan F. Boyle (D-Pennsylvania), Ranking Member of the House Budget Committee.

At the July 12th Senate Budget Committee hearing, Whitehouse explained that his legislation would bring enough revenue from the wealthiest to ensure that Social Security benefits will be paid and on time for the next 75 years and beyond.

“Right now, the cap on Social Security contributions means a tech exec making $1 million effectively stops paying into the program at the end of February, while a schoolteacher making far less contributes through every single paycheck all year,” says Whitehouse at the hearing. “That’s not fair, and my Medicare and Social Security Fair Share Act would fix that by requiring contributions to Social Security on wages above $400,000,” said the Rhode Island Senator.  

Whitehouse stressed the importance of Social Security to his Rhode Island constituents, by mentioning their comments and thoughts. 

 “I rely on my Social Security as my only source of income.  I would find it impossible to continue to live independently if Social Security were changed, reduced or eliminated.  Social Security benefits were a contract between the federal government and its citizens,” said Robert of Pawtucket.

Another Rhode Islander, Antonella of North Providence, said: “I would be very sad and depressed if there were any cuts to Social Security.  I just get by as it is.” And Laurel of Pawtucket said that without Social Security, she “would have to go back to work and probably have to work until I die.” 

Earlier this Congress, Senators Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) introduced their own bill, S. 393, the Social Security Expansion Act (Whitehouse is an original cosponsor).   The Sanders-Warren bill would expand benefits by $ 2,400 each year while fully funding the program for the next three-quarters of a century and beyond.

As to the GOP position on Social Security, the House Republican Study Committee released a plan to cut Social Security by $718 billion over 10 years.  This plan, endorsed by three-fourths of the  House GOP Caucus), would also raise the retirement age to 69 (for everyone who is currently 59 and younger), which would effectively cut benefits by an estimated 13 percent every year and especially harm low-income workers.  It would also reduce benefits for future beneficiaries who earned a “higher salary” before retirement. Also, only “modest adjustments” to the Social Security program as it operates would be made but it doesn’t clarify the changes.

It is important to note that three fourths of the House GOP caucus endorse the RSC budget, making cuts to Social Security and Medicare.

According to SSW’s Altman, while Democratic proposals (Larson, Whitehouse and the Sanders- Warren proposals) to expand Social Security and Medicare are popular with Democratic, Republican and independent voters, Republican politicians have chosen to not co-sponsor any of these bills.

My final thoughts…

Polls show that Social Security and Medicare, two of the nation’s largest social safety net programs, are extremely popular. According to a poll released in March 2023 by the Associated Press and NORC Center for Public Affairs research, 79% of Americans are opposed to reducing the benefits that Social Security beneficiaries receive.  As to raising Social Security’s eligibility age from 67 to 70, 75% of American’s were against it.

Another poll released last March found that nearly 9 in 10 Americans say they oppose reducing spending on Social Security or Medicare, according to polling from Axios.  

The Congressional debate on financially shoring up Social Security and expanding benefits is of   extreme interest to 66 million older and disabled people (175,840 beneficiaries in Rhode Island), who rely on monthly payments from the program.  But the Social Security debate must include America’s younger generations, too. 

With 477 days left before the 2024 presidential elections, expanding Social Security and making the program fiscally sound and to ultimately be available to Gen Exers (1965 to 1979), Millennials (1980 to 1994), Gen Z (1995-2012) and Gen Alpha (2013 to 2025) must become a key election issue. Social Security beneficiaries and America’s younger generations must call on Congress to expand Social Security benefits and ensure its fiscal viability for every generation.  “Keep Your Hands Off Social Security” must be the powerful message they send to all presidential and congressional candidates before the upcoming 2024 presidential election.     

To review the text of Larson’s H.R. 4583, “Social Security 2100: A Sacred Trust Act,” go to https://larson.house.gov/sites/evo-subsites/larson.house.gov/files/evo-media-document/final-2023.07.11-text-of-social-security-2100-act.pdf.

To watch a video of Larson’s May press conference announcing the upcoming introduction of H.R. 4583, the Social Security 2100, go to https://www.youtube.com/watch?v=WO8QYRRQ-UQ.

Here is a copy of RSC’s FY 2024 Budget, Protecting America’s Economic Security https://hern.house.gov/uploadedfiles/202306141135_fy24_rsc_budget_print_final_c.pdf.

New Census data reports the graying of U.S. population 

Published in RINewsToday on June 26, 2023

The nation’s population continues to gray and this is documented by a series of demographic profiles from the 2020 Census recently released. The release of this updated census data must be a wake-up call to Congress and federal and state officials who oversee aging programs and services.

According to Zoe Caplan, statistician demographer in the U.S. Census Bureau’s Sex and Age Statistics Branch, the U.S. population age 65 and over grew from 2010 to 2020 at the fastest rate since 1880 to 1890. The nation’s over-age-65 population grew nearly five times faster than the total population over the 100 years from 1920 to 2020, says Caplan in a May 25, 2023 posting on the agency’s website.

In her posting, Caplan says that in 2020, a whopping 1 in 6 people in the United States were age 65 and over. In 1920, this statistic was just 1 in 20. 

The 2020 Census reported that the older population increased by 50.9 million, from 4.9 million (or 4.7% of the total U.S. population) in 1920 to 55.8 million (16.8%) in 2020. This represents a growth rate of about 1,000%, almost five times that of the total population (about 200%).

Growth in older population spiked 2010-2020

According to Caplan, the older population has been growing for the past century but the decade before 2020 saw its fastest increase since 1880 to 1890. “From 2010 to 2020, the age 65 and over population experienced its largest-ever 10-year numeric gain — an increase of 15.5 million people. The next largest 10-year numeric increase, 5.7 million between 1980 and 1990, was less than half that size,” she says.

From 2010 to 2020, Caplan stated that the 65 and over population experienced the largest-ever percentage-point increase, from 13.0% to 16.8% of the total population. “Before 2010, it took 50 years (from 1960 to 2010)  for the nation’s older population’s share of the total population to grow by the same number of percentage points,” she said.

The 2020 Census Data reveals that while the nation’s population grew from 2010 to 2020, the size and rate varied by age groups for other age groups. The 65 to 74 age group was the largest of the older cohort groups, with 33.1 million people, representing over half of the age 65 and over population (or 1 in 10 Americans), she said.

“The 65 to 74 age group experienced the largest growth of any older age group the previous decade,” says Caplan, noting that its numbers grew by 11.4 million or (52.5%), increasing from 21.7 mil­lion in 2010 to 33.1 million in 2020.  

Caplan says that the 75-to-84 age group grew at about half that rate (25.1%) but is expected to pick up the pace in the next decade as baby boomers age into this group. Additionally, she noted that the 85-to-94 age group had a relatively slower growth (12.6%) than other older age groups, increasing from 5.1 million to 5.7 million.  The population 95 years and over also expe­rienced a large growth rate (48.6%), increasing from about 425,000 in 2010 to 631,000 in 2020, she added. 

The 2020 date also indicated that for those people age 70 and over, males experienced a larger percentage growth between 2010 and 2020 (42.2%) than females (29.5%). Meanwhile, the percentage of centenarians have grown 50% since 2010, the fastest recent census-to-census percent change for that age group.  

Finally, while the U.S. population age 65 and over population grew, the Census 2020 data indicated that the nation’s population remained relatively young when compared with other nations. Caplan noted that Japan has the largest percentage (28.5%) of older residents.  Many European countries, along with Canada and Hong Kong, have larger percentages of older residents than the United States, says Caplan, noting that the United States ranked 34th (16.8%) among these places.

Japan had the largest share (28.5%) of older residents. The United States ranked 34th (16.8%) among these places. Many European countries, along with Canada and Hong Kong, had higher shares of older residents than the United States, adds Caplan.

Nation’s median age creeps closer to Age 40

Just last week, the U.S. Census Bureau reported that the nation’s median age increased by 0.2 years to 38.9 years between 2021 and 2022.  Median age is the age at which half of the population is older and half of the population is younger.

“As the nation’s median age creeps closer to 40, you can really see how the aging of baby boomers, and now their children — sometimes called echo boomers — is impacting the median age. The eldest of the echo boomers have started to reach or exceed the nation’s median age of 38.9,” said Kristie Wilder, a demographer in the Census Bureau’s Population Division in a statement released on June 22, 2023.

“While natural change, nationally, has been positive, as there have been more births than deaths, birth rates have gradually declined over the past two decades. Without a rapidly growing young population, the U.S. median age will likely continue its slow but steady rise,” she says.

According to the statement, a third (17) of the states in the country had a median age above 40.0 in 2022, led by Maine with the highest at 44.8, and New Hampshire at 43.3. Utah (31.9), the District of Columbia (34.8), and Texas (35.5) had the lowest median ages in the nation. Hawaii had the largest increase in median age among states, up 0.4 years to 40.7.

No states experienced a decrease in median age. Four states — Alabama (39.4), Maine (44.8), Tennessee (39.1), West Virginia (42.8), and the District of Columbia (34.8) — had no change in their median age from 2021 to 2022.

Can Rhode Island cope with a population growing older?  

“It is no secret that the Rhode Island population is growing older,” says Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, whose Subcommittee was charged with looking at Rhode Island’s older population, its demographics, services and programs to assist them to age in place in the community along with identifying gaps in services. “We issued a comprehensive report in 2016 showing that persons age 65 and over in Rhode Island would go from 14.4% of the state population in 2010 to 25% by 2040,” she said.  

According to Maigret, the US Census 2021 estimates shows the state’s 65 and over population is now at 18% and some its communities have already reached 20%. “Our older population is also becoming more diverse. White older adults went from 93.4% in 2010 to 86.4% in 2021 (RI Healthy Aging Data Report.) while Hispanic older adults increased from 3.8% to 6.5%. Our Subcommittee continues to work to implement recommendations we made in nine different areas important for aging in the community,” adds Maigret, noting that she has been working with advocates and legislative champions to implement and put them into law or practice.

“We have made some significant progress in expanding home care for those not impoverished enough to be on Medicaid, to expand respite services for caregivers and this year to fund the Office of Healthy Aging and Disability Resource Center. But we still have much more work to do,” says Maigret.

“I am especially concerned that studies show some 80% of persons age 65+ will not be able to afford two years of home care and many may need more than that. So that is something we need to address by changes in Medicaid and Medicare providing support for unpaid family caregivers who provide enormous amounts of long-term care to loved ones in need.  We also be providing more funding for local senior center programs that are shown to promote health and reduce social isolation with its negative health outcomes,” says Maigret.

Maigret says that funding for the Village Common of RI that, an organization that provides trained and vetted volunteers in local villages to provide supports such as transportation to medical appointments, grocery shopping, friendly visits, minor home tasks — all types of supports to help older adults remain in their own homes, should also be allocated. “More communities are interested in starting these types of volunteer programs of mutual support but funding is needed to support the infrastructure,” she advises.  

Maigret expresses concern that so many older Rhode Islanders are economically insecure. Twenty seven percent of older households are living on less than $25,000/year yet it costs an older Rhode Island couple in good health renting their home about $41,448 annually to meet basic living expenses (Elder Index).

“Economic insecurity is a special problem for older women who comprise 56% of the state’s 65 and over population and are more likely to live alone,” she says noting that their average Social Security checks amounts to $11,584 compared to $14,578 for men, and mean personal income for women is about $25,000 less than older males.

Maigret encourages state leaders to pay attention to these “age-related” demographics as they consider budget and policy priorities. And she would like to see each of the state’s communities assess their age-friendliness, like Newport, Cranston and Providence have done.” Other communities should follow Pawtucket’s lead of promoting fitness for older adults by creating  adult outdoor exercise area adjacent to its senior center or in local parks.

Addressing the State’s Shrinking Health Care Workforce

“The main focus in addressing issues related to meeting the needs of the state’s growing older population is to address the critical need for a robust healthcare workforce,” says John Gage, President & CEO of the Rhode Island Health Care Association.  “Reimbursement must support appropriate staffing levels at livable wages throughout the long-term care continuum – home care, assisted living residences and nursing facilities,” he says. 

“As the generations shift, there will be a greater need for long-term care supports and services with a shrinking workforce.  Sustainable funding is essential to the ability to provide this care, and it has never been more evident than today,” warns Gage.  “In the wake of the Covid-19 pandemic, current statistics from the U.S. Bureau of Labor Statistics indicate that Rhode Island’s nursing home workforce is down some 20% from pre-pandemic levels,” he says, stating a detailed analysis of the workforce for hospitals and nursing homes indicates that  nursing home RNs have declined by 16.5%, LPNs by 18.3% and CNAs by 25.4%.  It is estimated that, nationwide, recovery of the nursing home workforce will not occur until 2027 based on the small, incremental improvements quarter over quarter, adds Gage.

“Presently, 17% of our neighbors are aged 65 and older, and nearly a quarter (24%) are age 60 and above!  Recognizing this trend, we are actively engaged in anticipating and meeting the needs of our growing population of older adults in our state,” says Director Maria Cimini, of the Rhode Island’s Office of Healthy Aging.

“At numerous State and non-profit spaces, we are present to ensure that the needs of older adults are central to discussions surrounding  health care, housing, transportation, education, accessible communities, and caregiving,” she adds.

“We embrace the opportunity presented by the recently passed Legislative Commission to Study the Services and Programs for Older Adults to collaborate with Rhode Islanders working with seniors. Together, we will share our experience with aging populations, promote valuable resources, and identify what we all need to make RI a great place to grow up and grow old,” says Cimini.

For a copy of the 2020 Census Brief, “The Older Population: 2020,” go to https://www2.census.gov/library/publications/decennial/2020/census-briefs/c2020br-07.pdf.

For a copy of the LTCCC’s Aging in Community Subcommittee June 2016 Report, “Aging in Community” go to  https://www.rilegislature.gov/Reports/AiC%20Full%20Final%20Report%206.13.16.pdf.

For a copy of the LTCCC’s Aging Community Subcommittee December 2016 Strategic Plan, “Aging in Community, go to https://www.rilegislature.gov/Reports/Building%20an%20Age-Friendly%20Community.pdf.

For a copy of Rhode Island Healthy Aging Data 2020 Report, go to

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Nursing home workforce crisis deepens with minimum staffing standards

Published in RINewsToday on February 13, 2023

“The long-term care industry is enduring the worst workforce crisis in its history, in Rhode Island, and across the country. Although providers are committed to recruiting and retaining staff to provide quality care for residents, despite our best efforts, many nursing homes have fallen short of the staffing ratio set by the RI Department of Health,” notes James Nyberg, Executive Director of the East Providence-based Leading Age Rhode Island (LARI), representing nonprofit providers of aging services.

“We are extremely  concerned about the impending fines that will be imposed on nursing homes here in Rhode Island as a result of our state’s existing nursing home minimum staffing ratio statute,” said Nyberg. Because of staffing ratio mandates, “the industry would have faced fines of over $11 million, in just one sample quarter (April – June 2022), since over 70% of nursing homes are not in compliance,” he said.  

“While April-June was a sample, the fines go into effect for July-September and we will receive a similar notice in just a few weeks, with only 10 days to pay the fine,” says Nyberg, stressing that these fines will only increase going forward if nursing homes are unable to meet the minimum staffing ratio.

Nyberg calls on the Rhode Island General Assembly to rescue Rhode Island’s nursing homes and provide relief from these penalties by delaying them and exploring an alternative approach to support the efforts of nursing homes to meet the ratio.  He warns that the current fine-based approach is excessive and counterproductive and will lead to reduced access to care and threaten the survival of the state’s nursing homes.

Nyberg points out that the current workforce shortages are already preventing nursing homes from filling open positions, limiting new admissions, and forcing organization closures (five nursing homes have already closed since the COVID pandemic began).  These challenges are also resulting in backlogs at hospitals, which are unable to discharge patients due to reduced capacity in nursing homes.  

“We are working with numerous stakeholders on various initiatives to develop a pipeline of workers, but the simple fact is that it will take time.  In addition, as you know, the industry has faced years of underfunding from Medicaid, which pays for the majority of nursing home care.  This has made recruiting and retaining workers more difficult than ever,” says Nyberg. 

John Gage, President of the Rhode Island Health Care Association (RIHCA) agrees with Nyberg’s assessment of the nursing home workforce.  “Nursing homes across the nation are facing an historic labor shortage as the direct result of chronic Medicaid underfunding and the devastating impact of the Covid-19 pandemic on the workforce, he says, noting that the state’s nursing home workforce is down 20% since the start of the pandemic, with 2,000 workers lost from Jan. 2020 to June 2022.  Nationwide, the nursing home workforce is down 210,000 workers.

According to Gage, Rhode Island’s staffing mandate, while well-intentioned, will siphon tens of millions of dollars from resident care. In the first year of full implementation of the state’s minimum staffing mandate, RIHCA estimates that facilities will be fined upwards of $60 million. “These fines will imperil care, not bolster it,” he warns.  

Without legislative action, Rhode Island nursing homes will be fined an estimated $11 million on or about February 28, 2023, because of their inability to attract workers to meet the mandate from July 1, 2022, through September 30, 2022, Gage charges. “There are simply not enough available workers to fill the open staff positions, and resources are scarce.  Nursing homes will be devastated by these fines.  Facilities will reduce admissions, backing up hospital referrals and clogging hospital beds.  More nursing facilities will close – five have already closed since the beginning of the pandemic,” he predicts.  

Gage asks, “Who will care for Rhode Island’s frailest elders?” To recreate a minimum staffing mandate in nursing homes on the federal level would be a huge mistake, especially given the historic workforce crisis here in Rhode Island and nationwide,” he says.  

Gage’s comments echo concerns expressed by another group of US Senators in Jan. 20 correspondence (https://www.tester.senate.gov/wp-content/uploads/1-20-23-Nursing-Home-Staffing-Mandate-Letter-FINAL.pdf) sent to CMS by Senators John Bourasso, Jon Tester, and eleven other US Senators.  They caution the agency that a one-size fits all mandate would undermine access to care for patients, and they encouraged CMS to work with Congress on tailored solutions that address the workforce challenges facing nursing facilities.

At the federal level

Just days ago, U.S. Senators Bob Casey (D-PA), Chairman of the Senate Committee on Aging, and Ron Wyden (D-OR), Chairman of the Senate Finance Committee, called on the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure to encourage the federal agency to establish minimum staffing standards in nursing homes to ensure high-quality care for nursing home residents. In Feb. 10 correspondence, Casey and Wyden, along with Senators Sherrod Brown (D-OH), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Cory Booker (D-NJ), and Elizabeth Warren (D-MA) urged CMS to advance the agency’s ongoing study to determine adequate staffing requirements in nursing homes.

“We appreciate the work that CMS has undertaken to promote safety and quality in nursing homes and applaud the Biden-Harris Administration’s commitment to protecting our nation’s seniors,” said the senators in Feb. 10 correspondence, urging CMS to “bring this work to completion.” 

“In our view, that means continuing the agency’s ongoing study to determine the level of staffing that is necessary to ensure safe and high-quality care for nursing home residents, developing an evidence-based and actionable proposal for mandatory minimum staffing levels, and a robust and transparent process—including direct stakeholder engagement— that will allow for further discussion and fine-tuning of requirements before the proposal is finalized,” wrote the senators.

The senators noted that studies have shown a correlation between inadequate staffing levels and lower quality of care. More recent studies have demonstrated that higher nurse staffing ratios mitigated the effect of COVID-19 outbreaks in nursing homes and resulted in fewer deaths. A recent Department of Health and Human Services Office of Inspector General report examining the high level of COVID-19 infections in nursing homes also pointed to the need for the establishment of minimum staffing requirements.  

In the correspondence, the senators cite the Social Security Act, which requires skilled nursing facilities to “provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents,” including the services of a registered nurse at least 8 consecutive hours per day, 7 days a week. The letter commends CMS for working to update this vague standard that has led to substantial variation in staffing levels and quality of patient care across facilities.

“Achieving the shared goal of ensuring quality care in nursing homes nationwide is a complex undertaking, says LeadingAge’s Ruth Katz, senior vice president, policy. LeadingAge is an association of nonprofit providers of aging services, including nursing homes.

“As our Get Real on Ratios proposal highlights, a number of conditions must be met in advance of any mandate implementation,” suggests Katz. “The senators correspondence to CMS is a promising development; it covers many of the same points as our Get Real on Ratios proposal – a recognition of the critical need for adequate reimbursement; that one size does not fit all, and that workforce shortages will need to be addressed with additional support. Without addressing these, staffing mandates are impossible. We look forward to continuing our discussions with Congressional leaders on this critical issue so that older adults and families can access much-needed care and services,” she says.

“The Senior Agenda Coalition of RI fully supports the need to develop national staffing standards to ensure quality care is provided to nursing home residents across our nation. It is important to note that Rhode Island has been a leader in this area. For many years our state has required 24/7 RN coverage in nursing homes and in 2021 the legislature passed the Nursing Home Staffing and Quality Care Act that includes staffing standards,” says Maureen Maigret, Policy Advisor to Senior Agenda Coalition of RI. “Now we must work to address workforce shortage issues and ensure that adequate government resources are provided especially through Medicaid payments so the standards can be met, and our critical direct care workers receive competitive living wages in order to keep them working in long term care,” she adds.

As the House Leadership hammers out the FY 2024 budget, it is crucial that adequate Medicaid funding is allocated to allow nursing homes to attract the necessary staff to meet the state’s minimum nursing standards that it codified into law. We must address this policy problem now rather than just kick the can down the road.