How the Unfunded Nursing Home Staffing Mandate Can be Funded

Washington handed down a staffing mandate to skilled nursing facilities earlier this year – requiring that as we come out of the Covid fog still facing an unprecedented nursing, physician and allied health professional shortage, we must hire a certain number of staff that the federal government deems sufficient for the delivery of high quality care. And if we don’t – here come the penalties. As I said in a previous Founder’s Message on this topic, certified nurse aides and nurses don’t just materialize out of thin air. And if you are trying to attract qualified individuals to long term care communities in rural or just outside rural areas, you are going to have to make it financially attractive for them to begin the commute. Financial incentive is a part of every sector and looking for it in pursuing a new position is just a rational person’s objective. Those taking care of seniors also have to take care of their own families.

In reading McKnight’s Long Term Care publication, I came across this illuminating idea from one of its editors.  Here’s the context:

Take, for example, what Medicare Advantage and other dubious insurers have been accused of by no less than the Wall Street Journal. “Insurers pocketed $50 billion from Medicare for diseases no doctor treated” read the headline this week. Extra MA payments kicked in for situations that were described as “anatomically impossible.” 

That’s $50 billion — with a ‘B,’ mind you.

That could pay for, oh, say a decade’s worth of the nursing home staffing mandate, according to just about everybody’s cost estimates.

Moreover, it could buy a lot of time to grow the pipeline to attract and educate a whole bunch of registered nurses that are called for in the mandate but don’t yet exist in great enough numbers.

Let’s think about these facts for a moment. Some of the nation’s largest insurers are raking in $50 billion from Medicare under suspicious claims.  And, as McKnight’s reports:

The huge insurer profits aren’t just left to gather dust in a vault in the boardroom, either. Some of these same companies devouring the marketplace — and so much of Uncle Sam’s largesse — are also funding “consumer” campaigns like the one aiming to keep the nursing home staffing mandate in place.

While long term care providers struggle to meet an untenable mandate, money going to insurance companies who are paid to protect access to and coverage for medical services necessary to improve our seniors’ health outcomes and quality of life – is being gobbled up – leaving an absence of resources of funding that could easily be met by the insurers themselves. That said, the funding wouldn’t be leaving health care systems and services and going to insurers if the outrageous claims reported by the Wall Street Journal hadn’t been made and insurers did their job ethically and fairly.

Something is terribly wrong and it has to be made right.

Mark McKenzie

Founder & CEO