The National Consumer Voice for Quality Long-Te rm
Care is a 501(c)(3) nonprofit membership
organization founded in 1975 that advocates for
quality care and quality of life for consumers who
receive long-term care.
1025 Connecticut Avenue, NW
Suite 1000
Washington, DC 20036
202.332.2275
info@theconsumervoice.org
theconsumervoice.org
March 5, 2024
The Honorable Jason Smith The Honorable Richard Neal
Chairman Ranking Member
Committee on Ways and Means Committee on Ways and Means
U.S. House of Representatives U.S. House of Representatives
Dear Chairman Smith and Ranking Member Neal:
The National Consumer Voice for Quality Long-Term Care (Consumer Voice) urges
the Committee to reject H.R. 7513, which would prohibit the Centers for Medicare
and Medicaid Services (CMS) from fulfilling its regulatory duty of creating safe staffing
standards in nursing homes. Consumer Voice is the leading national voice
representing consumers in issues related to long-term care. We are a primary source
of information and tools for consumers, families, caregivers, advocates, and
ombudsmen to help ensure quality care for the individual. Consumer Voice has
nearly 50 years’ experience advocating for quality nursing home care. Strong federal
minimum staffing standards are necessary to protect resident health and safety.
Despite the recommendation for minimum staffing levels in a CMS Study more than
20 years ago, no standard was ever established. Instead, the vague requirement of
having “sufficient staff” has resulted in widely varying staffing levels across facilities,
and subjected residents to substandard care, and staff to untenable working
conditions.
During the COVID-19 pandemic, over 200,000 residents and workers died from
COVID-19. Countless others died from isolation and neglect. To address the
underlying problems that resulted in the devastation in nursing homes, President
Biden announced an ambitious set of reforms, the centerpiece of which was a
minimum staffing standard. Importantly, these reforms enjoy great public support,
with one survey from AARP finding that 80% of respondents supported a minimum
staffing standard.
Hundreds of studies have found that nursing homes that provide high-quality staffing
have better health outcomes for residents. Residents living in nursing homes with
less staff experience higher levels of pressure ulcers, falls, neglect, and abuse. A
strong minimum staffing standard would promote high quality care for all residents
and help protect them from harm and neglect in nursing homes.
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Since announcing its intent to set a staffing standard, CMS issued a Request for
Information, undertook a study, and proposed a regulation which solicited tens of
thousands of comments from stakeholders. All interested parties, including the
nursing home industry, have had ample opportunity to provide input into the
feasibility and substance of any standard. HR 7513, however, seeks to bypass this
established process and prohibit CMS from promulgating not only this rule, but any
rule that would create a staffing standard. Such an action would perpetuate
substandard conditions that currently exist for many nursing home residents.
In a new Consumer Voice survey report of more than 120 nursing home residents,
88% stated their facilities lacked the staff necessary to meet the needs of the
residents living there. 87% of residents said understaffing affects them every day or
several times per week; and 74% reported that they, or someone they know in their
facility, has been neglected or hurt because of understaffing. Residents’ comments
included:
• “Aides say they have too many people to take care of. I have to wait.”
• “I’ve waited up to three hours for help and that’s just one of many everyday
occasions.”
• “I have endured so much medical and emotional neglect. Staff are so
stressed.”
Importantly, the staffing standard proposed by CMS is quite modest. It would only
affect the most poorly performing homes and provides waivers to facilities who make
good faith efforts to meet the regulatory requirements. The proposed implementation
times are also quite generous to providers, more than three years for most facilities,
and additional time for rural providers.
Claims that there are no people who want to work in nursing homes do not tell the
whole story. The average turnover in nursing homes annually is 52%, according to
CMS. Nursing home workers leave because they are underpaid, overworked, and
under-appreciated. Competitive compensation and improved working conditions
must be a priority to retain current staff, as well as recruit new staff, and entice those
that left or were let go during the pandemic to return. These are steps providers can
start taking now. Additionally, efforts are already underway at CMS and other
agencies around workforce development to support efforts to recruit and train new
caregivers.
Further, safe staffing is possible. Thousands of nursing homes, mostly non-profit
facilities, currently staff well above the standard in the proposed rule. In fact, non-
profit homes staff nearly 25% higher than for-profit nursing homes, with much less
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turnover. We must seek to address why nursing home residents receive such
disparate care, not derail a process for protecting residents.
Nursing homes receive more than $80 billion taxpayer dollars through Medicare and
Medicaid to care for our nation’s most vulnerable seniors. It is not unreasonable that
we should expect quality care for those dollars. Requiring baseline staffing levels is a
critical step for achieving dignity and quality for those residents. Thus, we urge the
Committee to reject H.R. 7513.
If you have any questions, or need additional information, please contact Sam
Brooks, Director of Public Policy, at sbrooks@theconsumervoice.org.
Sincerely,
Lori Smetanka
Executive Director
