How a new national staff mandate would affect Iowa nursing homes

Minimum nursing home staffing standards would be established for the first time nationally under a proposal made by President Biden's administration in September.

• The Centers for Medicare and Medicaid Services' public comment period for the plan ends today.

Why it matters: There's widespread disagreement about whether mandated staffing would improve care for patients or exacerbate worker shortages and long-term care facility closures.

• The issue is particularly stark in Iowa, where almost 96% — 387 of the state's 404 nursing homes — don't meet the staffing benchmarks, according to estimates from the Iowa Health Care Association (IHCA) based on federal staffing data.

Zoom in: Under the proposal, nursing homes that receive payments through Medicare or Medicaid would be required to provide a minimum of 33 minutes of care from a registered nurse and two hours and 27 minutes of care from a nurse aide per resident per day.

• They'd also be required to always have a registered nurse on staff.

By the numbers: Iowa facilities would need to hire a total of about 360 additional registered nurses, almost 1,100 nursing assistants and more than 1,400 additional direct care staffers, according to IHCA's estimates.

What they're saying: Brad Anderson, AARP Iowa's director, tells Axios that the proposal is what experts believe is the right amount of staffing needed to reduce pervasive problems documented in the long-term care industry.

• How it's implemented will influence how or whether additional long-term care facilities close in Iowa, he says.

The other side: The proposal is "an unfunded and illogical federal staffing mandate," IHCA CEO Brent Willett said in a statement provided to Axios.

• It would require long-term care facilities to "hire people who do not exist to care for people who do," he said in reference to Iowa's labor shortage.

Meanwhile, Gov. Kim Reynolds joined 13 other Republican governors last week in a letter asking President Biden to reconsider the staffing rule.

• That prompted a response from State Sen. Claire Celsi (D–WDM), who asked Reynolds to set aside partisanship and come together to find solutions.

What's next: CMS will consider public comments after today's deadline.

• A final regulation could be forwarded to the Government Accountability Office and both houses of Congress for review in coming months.

Plus: Iowa Citizen Action Network will host a forum about the staffing proposal Nov. 14 at Franklin Avenue Library. 2-4pm.