Experts: Biden's 'Build Back Better' Boondoggle will Devastate Nursing Homes

WASHINGTON, D.C. – The Build Back Better Act, recently passed by the U.S. House of Representatives, includes two unfunded nursing home mandates that could force thousands of nursing homes to further limit the number of admissions in their facilities or even shut their doors for good.

The bill requires nursing homes to have a registered nurse (RN) on-staff 24 hours a day and requires the U.S. Department of Health and Human Services (HHS) to conduct a study on minimum staffing ratios and implement the regulations within one year without additional funding, yet offers no resources to providers to implement these provisions.

The intent of the measures is largely supported by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL). In particular, having a 24-hour RN on staff is a key component of AHCA and LeadingAge’s comprehensive reform proposal, the Care for Our Seniors Act. However, without funding or programs to recruit tens of thousands of more nurses, providers will be unable to fulfill these requirements. AHCA/NCAL recently held a press conferenceoutlining their concerns.

The Build Back Better Act mandates will cost nursing homes billions of dollars per year. AHCA/NCAL estimates that if the HHS study found that nursing homes need to increase clinical and direct care staff by 25 percent, it would require hiring more than 150,000 RNs, licensed practical nurses (LPNs) and certified nursing assistants (CNAs), costing $10.7 billion per year. The RN mandate would require hiring 21,000 more nurses, costing $2.5 billion a year.

Nursing homes are already facing a historic staffing crisis. Many caregivers have been burned out by the pandemic, and workers are leaving the long term care sector for jobs in other health care settings or other industries altogether. 

Hospitals, physicians’ offices, outpatient care centers and other health care facilities have reached or surpassed pre-pandemic staffing levels, but nursing homes and assisted living communities are still experiencing substantial job losses. October data from the Bureau of Labor Statistics (BLS) show nursing homes have lost 221,000 jobs since the start of the pandemic – a 14 percent employment level drop.

Chronic Medicaid underfunding and the billions of dollars spent to fight the pandemic have left providers struggling to compete for qualified staff. The inability to recruit and retain workers has led to many facilities having to limit the number of residents they serve, and some facilities have even had to close permanently. A September AHCA/NCAL survey found that 78 percent of nursing homes and 61 percent of assisted living communities are concerned that workforce challenges may force them to close.

Sadly, this is already a reality for nursing homes across the nation. Facilities in Illinois, Maine, Michigan, Nebraska, New Jersey, and New York, among others, have closed because of staffing shortages, while others in Texas, North Dakota, Oklahoma and Rhode Island have had to reduce or pause new admissions. If this continues, millions of seniors could face limited options for care.

Nursing homes have faced unprecedented challenges due to the COVID-19 pandemic. Lawmakers must help the long term care sector attract and retain more caregivers, so that our nation’s most vulnerable have access to the long term care they need and caregivers have access to good-paying, rewarding jobs.