Crushing federal mandate threatens NH nursing homes
As of last month, federal data showed nursing and residential care facilities had 218,200 fewer workers nationwide than they did just prior to the COVID-19 pandemic.
Rebuilding that workforce is an existential challenge, and not for lack of trying. As of the most recent state data, June of last year, the median wage for a licensed nursing assistant (LNA) in the Portsmouth area was $19.68 an hour. Indeed, looking online one can find nursing home wages of as much as $25.35 an hour for a LNA in the Seacoast area, plus sign-on bonuses.
And yet vacancies still exist, for there simply are not enough licensed staff to go around. Thus, facilities are forced to use staffing agencies, which can pay more by charging providers infinitely more than they pay the agency workers providers contract for. Consider St. Ann Rehabilitation and Nursing Center in Dover. Opened in 1958, it is part of Catholic Charities New Hampshire. Last year it had to spend over $1.4 million on staffing agencies, a terrible burden upon this great 5-star nonprofit facility. Today it has over a dozen LNA positions it would like to fill.
St. Ann is not alone. The New Hampshire Veterans Home offers a LNA no less than $42,244.80 a year plus benefits. And yet even the Veterans Home has been forced to utilize out-of-state staffing agencies, shipping – under its most recent contracts – no less than $35 an hour to addresses in Illinois, Maryland and Virginia for the services of LNAs, which would be $72,800 apiece over a work year.
Last year almost 200 U.S. House members, including both our state’s, asked the Biden Administration to respond to the fact such “agencies are vastly inflating price” and keeping “40% or more” as pure profit. And yet the Administration has done nothing about this piracy.
New Hampshire’s bipartisan budget made a very significant investment in the Medicaid funding that pays for the care of most residents in county and private nursing homes, as well as those in home and community-based settings (HCBS). This funding could, over time, assist with both recruitment and retention.
Yet a potentially crushing blow awaits in the form of an unfunded staffing mandate the Biden Administration threatens to inflict upon nursing homes, despite bipartisan alarm, including a letter from U.S. senators warning such a mandate “could lead to the shuttering of facilities, especially in rural communities.”
Nursing homes are already, due to staffing concerns, turning away discharge-ready hospital patients, which jams up hospitals. Two county facilities alone have wait lists of over 100 prospective residents each. Small wonder the American Hospital Association has expressed opposition to such a federal mandate. Hospitals here have already surrendered their own Medicaid funding increases to help nursing homes and HCBS care.
A national accounting firm estimated the mandate would cost nursing homes $11.3 billion a year and require hiring up to 191,000 new workers. This may be an underestimate. In New Hampshire, without available labor, only out-of-state agencies could even theoretically provide the workers such a mandate would require. Nor, as we have the nation’s second-oldest population, could closures be sustained, as county facilities could not accommodate displaced private facility residents. Locally, Strafford County’s Riverside Rest Home already needs replacing.
Thus, to pay runaway agency costs, and keep facilities open, an unfunded federal mandate would require very significantly raising the county property taxes that largely fund long-term care in the Granite State. If that happens, President Biden’s decision to skip our presidential primary would prove wise.