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Guest Column

Montana Leading the Charge to Support Seniors

Montana just doesn’t have the number of qualified workers to meet the Centers for Medicare and Medicaid Services’ requirements of its one-size-fits-all mandate

By Jason Cronk

Montana’s nursing homes are resilient. The past few years have reaffirmed our commitment to doing everything necessary to continue providing quality care to our elderly population. The Treasure State’s policymakers share that resolve and have continued to do their part to ensure our seniors have access to care. In the wake of a once-in-a-lifetime pandemic and historic staffing shortages facing the entire healthcare system, we have continued to make tremendous strides in the right direction.

Unfortunately, the Biden Administration’s proposed federal staffing mandate threatens to undermine any progress we have made.

State lawmakers increased the Medicaid reimbursement rate for nursing homes last year – an approximate $50 increase per day for Immanuel Living’s facilities. This increase puts us shy just of $90 of the actual cost of daily care. This helps further offset the cost of care and allows us direct resources toward other endeavors like workforce recruitment and retention.

In our nursing homes, we’ve implemented new incentives and programs to remain competitive in the current job market. We added a childcare benefit to attract new talent, and in the last two years we’ve hired a human resources talent acquisition coordinator to help us find qualified caregivers.

We continue to work with schools in our area to develop a strong pipeline of new caregivers and help the entire long term care sector and health care system. This includes creating internships in our nursing homes or implementing training programs for people to become certified nursing assistants. We put a strong emphasis on our work culture and creating an environment where folks want to work and make a difference.

We’ve decreased our use of costly staffing agencies, but the underlying problem facing workforce shortages remains – Montana just doesn’t have the number of qualified workers to meet the Centers for Medicare and Medicaid Services’ (CMS) requirements of its one-size-fits-all mandate.

Enforcing a federal staffing mandate in Montana is simply unrealistic. We do not even have enough schools or teachers to train additional caregivers. The mandate is demanding we hire more registered nurses (RNs) but if we don’t have enough qualified RNs in the current labor force already, it’s unreasonable to expect us to meet an arbitrary new quota.

Added cost is another major concern. One analysis found that meeting the federal staffing requirement would cost Montana $15 million annually. Even with our Medicaid rate increase, we wouldn’t be able to absorb this. Even worse, the mandate comes with no new federal dollars to help us hire the nurses and nurse aides we need.

To achieve compliance with the federal mandate, Montana nursing homes will have to turn prospective residents away or even worse, close for good. Montana saw 11 nursing homes close in 2022, which got the attention of our Legislature and led to our Medicaid reimbursement increase. Thankfully, we experienced no closures in 2023. However, if the federal staffing requirement is finalized, it’s only a matter of time until we do.

Sen. Jon Tester recently introduced bipartisan legislation in Congress to stop the Biden Administration’s federal staffing mandate. Sen. Steve Daines joined Tester and 26 other senators in signing a joint letter to CMS to express their concerns about the flawed rule. Rep. Matt Rosendale of Montana’s second congressional district has also cautioned CMS against this one-size-fits-all mandate. These are great examples of putting people over politics. The Montana delegation understands this isn’t a partisan issue but simply a flawed policy that will only hurt our seniors.

The bottom line is that a federal staffing mandate is asking us to do the impossible. The seniors we proudly serve deserve a more nuanced approach that partners with nursing homes to find the right staffing solutions, such as better investment toward recruitment and retention efforts. Let’s hope the Biden Administration never finalizes this misguided mandate.

Jason Cronk is the president and CEO of Immanuel Living, a not-for-profit long term care provider in Kalispell.

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