LeadingAge PA statement on U.S. Senate Member Letter to CMS Regarding Minimum Staffing Standards

By LeadingAge PA
November 9, 2023

LeadingAge PA statement on U.S. Senate Member Letter to CMS Regarding Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting (CMS-3442-P) 

MECHANICSBURG, PA (November 9, 2023) -- This week, a group of U.S. Senators, including Pennsylvania’s Bob Casey and John Fetterman, sent a letter urging the Centers for Medicare and Medicaid Services (CMS) to “strengthen and finalize” the proposed federal staffing rule for nursing homes. When LeadingAge PA and our members spoke with Senator Casey and Fetterman’s offices in recent weeks, we implored them to recognize the problematic nature of this mandate, including its failure to appropriately incorporate LPNs toward nurse staffing minimums, realistically address the workforce crisis, or provide commensurate funding to help providers comply with the proposed requirements.  

While we are glad to see the letter acknowledge the value of LPNs, the message coming out of the Senate still misses the mark. There is acknowledgement of the need for flexibilities based on stakeholder input, but we must be careful not to limit the need for these considerations only to rural areas. The workforce crisis is already severely impacting all regions in Pennsylvania. 


The Senators also request financial support for state survey agencies to help ensure oversight and enforcement of the mandate, but they fail to speak to the need for funding to help providers comply with the mandate in the first place. The $75 million investment through the Health Resources and Services Administration (HRSA) would only help bring a very small number of additional nurses into the field at best ($75 million stretched across all states would only cover tuition for a few RNs in each state), and we appreciate the recognition of the need for CMS to further support workforce initiatives, but ultimately providers will still need a significant amount of funding to even begin attempting to comply with the new standards. 


Perhaps the most misguided statement in the letter is the claim that, “it is clear that a staffing standard will help improve care and save lives.” This statement may be well-intentioned but is recklessly simplistic. A mandate itself, without an adequate workforce and funding for the providers who are bound to it, will not have the intended effect as we are seeing play out in Pennsylvania with new state staffing ratios. Qualified workers are what will improve care and save lives, but an unfunded, misaligned mandate of this nature won’t miraculously make them appear. Similarly idealistic is the idea that “a strong staffing standard will ultimately…help attract more workers.” This is a nice idea in theory, but it will not play out as expected. Instead, a mandate will force providers who are unable to find the required staff to take beds offline or worse, close altogether. This will not create an environment conducive to attracting additional workers to the field or providing care to Pennsylvanians at their most vulnerable time of need. 


We call on our Congressional delegation to recognize that a mandate will only cause a snowball effect of diminished access and quality erosion. We can’t establish an (arguably arbitrary) ideal without doing the work of creating and investing in a meaningful pathway for providers to comply with it.  



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About LeadingAge PA 
LeadingAge PA is a trade association representing more than 400 quality providers of aging services. These providers serve more than 75,000 older Pennsylvanians and employ over 50,000 dedicated caregivers on a daily basis. Services our members offer include life plan communities/continuing care retirement communities, skilled nursing communities, assisted living residences, personal care homes, home and community-based services, and affordable senior housing. LeadingAge PA advocates on behalf of our members at the state and local levels to influence positive change and affect a healthy vision for the delivery of quality, affordable, and ethical care for Pennsylvania’s seniors. For more information about LeadingAge PA and our envisioned future of senior services, visit www.LeadingAgePA.org


Media Contact:  
Katie Andreano, Sr. Dir., Marketing & Communications