this post was submitted on 22 Apr 2024
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The Biden administration finalized on Monday the first-ever minimum staffing rule at nursing homes, Vice President Kamala Harris announced.

The controversial mandate requires that all nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift, according to a White House fact sheet.

Plus, nursing homes must have a registered nurse onsite at all times. The mandate will be phased in, with rural communities having longer timeframes, and temporary exemptions will be available for facilities in areas with workforce shortages that demonstrate a good faith effort to hire.

The rule, which was first proposed in September and initially called for at least three hours of daily nursing care per resident, is aimed at addressing nursing homes that are chronically understaffed, which can lead to sub-standard or unsafe care, the White House said.

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[–] [email protected] 131 points 6 months ago (27 children)

The controversial mandate

I wonder what the controversy is...

Nursing home operators strongly objected to the minimum staffing proposal in September, saying they already struggle to fill open positions. Such a requirement could force some facilities to close.

Oh, of course, they don't want to pay people. These business owners should go back to econ 101, the labour market is just another market. If you can't get enough people at current prices, you need to PAY MORE.

Mark Parkinson, CEO of the American Health Care Association, said in a statement Monday. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis.”

Oh, it's funded. Two steps. Grab your wallet, Mark. Look in your wallet. There is your funding.

The proposed staffing mandate has also split Congress, whose approval is not required. A bipartisan Senate bill and similar legislation introduced by House Republicans would prohibit the Department of Health and Human Services from finalizing the rule.

The only time you can reliably expect the US Congress to actually do anything for their fat paychecks is when it has to prevent other people in government to do their jobs.

[–] [email protected] 40 points 6 months ago (1 children)

Every point you made is legit, but just like psychiatric hospitals and asylums of yore, the statement you quoted is a threat that they (the profit-based company) will just stop operating certain locations if people (or the government) don't pay up. They will literally leave the elderly in the front parking lot and shut the place down if they can't keep their profit margins is what I'm reading into that statement.

For those unaware, I'm referring to the Reagan administration coming down hard on discontinuing the funding for a lot of government funded psychiatric and elderly care facilities in the 80's. You can read the Wikipedia article, but it doesn't really address the insane power these awful and privately operated companies hold over an entire segment of the population in this country, and hold tax dollars as ransom "or else".

That man in that quote is making a thinly veiled threat to repeat this shit again.

[–] [email protected] 24 points 6 months ago (4 children)

There's a difference. Psychiatric facilities struggle with funding, nursing homes ABSOLUTELY do not. Have you seen the cost of living in even the shittiest nursing homes? It's common practice to be paying upwards of $10,000 per month, per resident. Nursing homes have all the money they could ever want, they're just greedy fucks who purposely utilize dangerously understaffed facilities to maximize profit for those at the top.

[–] [email protected] 8 points 6 months ago

They were lumped together in the Reagan administration culling payments for all times of those though. There are few protections for the elderly even still. You don't need to dig deep and find a zillion hits about these companies raising care rates out of nowhere to vacate tenants. It's absolutely insane, and there should be laws against it top to bottom.

[–] [email protected] 5 points 6 months ago (1 children)

Plenty of states it's much higher, in Minnesota the rate is set by the state according to patient need. It's not unheard of to pay $15k a month as $14k month is the average cost per resident.

[–] [email protected] 3 points 6 months ago

To aid in contextualizing this they are being asked to spend at least $2,500 of the $14,000 on labor which isn't remotely unreasonable

[–] [email protected] 3 points 6 months ago

Yep, and they pay CNAs subhuman wages so they’re staffed by anyone who can pass a piss test. (My local gas station sells “fetish urine” lol).

My boyfriend had to put in some hours at a long term care facility as part of nursing school. Absolutely disgusting stuff happens there - the CNAs do not give a fuck (which makes sense, it’s not like you’re making that much better than Macca’s)

[–] [email protected] 0 points 6 months ago (2 children)

$120K per year per resident isn't that much revenue to cover 24 hour availability of care, food, lease, etc.

I'm not saying it is unworkable, but with the requirement for 3.5 hours of nurse care or resident per day, that means the maximum total cost of a Nurse is $95 per hour, or about $190K.

That really isn't much - typically employees cost a business twice their base salary. So the nurses can be paid $100K per year while leaving almost $0 for any other expenses..

[–] [email protected] 5 points 6 months ago (2 children)

How are you getting $95 an hour?

[–] [email protected] 1 points 6 months ago
[–] [email protected] 1 points 6 months ago (1 children)

3.5 hours of nurse care per resident per day (from the bill).

Resident pays $120K per year to stay at the facility.

There are 365*3.5 hours in a year they need nursing care = 1277 hours of nursing care per year per client.

$120K per year / 1277 hours per year = $94/ hr maximum cost for each nurse - assuming there are no other expenses for the facility.

Must have mistyped to get $95, but that is the math.

[–] [email protected] 3 points 6 months ago (1 children)

Okay, now I understand what you meant by maximum cost. It should be noted that the nurses will likely be paid closer to $30 / hour, give or take depending on the area.

[–] [email protected] 1 points 6 months ago* (last edited 6 months ago) (1 children)

The $94/hr isn't a salary, it's the cost to the business. Employees generally cost a business 1.3-1.5X their salary - since insurance, payroll taxes, PTO, etc. all also need to be paid for.

Again this is not considering any other cost for the facility: utilities, food, other staff, medical equipment, maintenance, insurance, rent...

[–] [email protected] 3 points 6 months ago (1 children)

I'm not worried about their profits tbh. Nursing homes had total net revenues of $126 billion and a profit of $730 million (0.58%) in 2019. They can afford to staff properly and fairly and still make a disgusting amount of profit.

[–] [email protected] 2 points 6 months ago (1 children)

That is an insanely small margin, and directly contradicts your claim that they can staff properly.

Let's take the entire profit for the industry and hire nurses. Let's say reach nurse costs $80K ( $60K salary, $20K for taxes/insurance/other benefits).

That pays for 9600 more nurses. Which, given the nursing requirements in the bill (3.48 hours per day per resident), only covers staffing for 22K residents.. a rounding error to the more than 1.2 million nursing home residents in the country.

There are ~15K nursing homes in the US, each of them getting 0.6 more nurses doesn't help anything.

[–] [email protected] 1 points 6 months ago (1 children)

I'm no economist, but if the business can't afford to perform its function (such as a care home taking care of its residents) then the business shouldn't exist.

[–] [email protected] 2 points 6 months ago (1 children)

And that is a valid opinion. Unfortunately what do you do with all these people if the homes close because they can't afford staff?

The intent of the bill is to prevent neglect in nursing homes - that is a worthy and important goal. The mandate doesn't actually help make that happen.

It doesn't provide funding the care providers to increase staff, it doesn't add incentives for individuals to get certified and help address the personnel shortage, it doesn't put a cap on administrative costs for care facilities, it doesn't actually DO anything to help solve the problem.

Good mandates also provide an avenue to meet them.

[–] [email protected] 2 points 6 months ago (1 children)

The government is already providing funding, this just makes that funding dependent on having enough staff.

If a business needs the government to hold its hand every step of the way to be successful then it should be a government facility instead of a private business.

[–] [email protected] -1 points 6 months ago (1 children)

We get it, you don't like nursing homes.

You don't seem to be engaging with the substance of the matter, so I'll leave it here.

[–] [email protected] 2 points 6 months ago (1 children)

I like nursing homes. I don't like nursing homes that don't take care of their residents.

That is the substance of the matter here. I don't care how profitable the business is if the residents aren't being properly cared for.

[–] [email protected] 1 points 6 months ago (1 children)

The businesses are hardly profitable. For every dollar they get from housing a resident, they get just above half a penny of profit.

As I showed above, you can take the entire profit and put it into hiring more staff and it won't actually make a difference. They either need to raise prices, cut costs elsewhere (maybe administration? I'm not familiar enough to know), or pay people less.

That's what the numbers say.

[–] [email protected] 1 points 6 months ago (1 children)

Again: I don't find the argument "we can't take proper care of our residents because it's not profitable" to be compelling.

No one seems to be arguing that the care being asked for is unnecessary, just that it's expensive. And in that case I just don't care.

[–] [email protected] 0 points 6 months ago (1 children)

Again, it doesn't matter whether you find the argument about compelling.

If care cannot be provided profitably, it won't be provided at all. That is reality. Somehow, the care must be paid for.

Those who need care are not better off if these facilities close.

[–] [email protected] 1 points 6 months ago

If a business needs the government to hold its hand every step of the way to be successful then it should be a government facility instead of a private business.

[–] [email protected] 3 points 6 months ago

Most of that labor can be filled by nurses aids which make on average $17 an hour not $90

[–] [email protected] 37 points 6 months ago

Mark Parkinson is a trash human being. Let his name forever be dragged through shit in search engines.

[–] [email protected] 6 points 6 months ago (1 children)

Chances are that Mark Patterson is not a medical service provider. I am sure he is very well compensated, but he would be association staff, not industry.

[–] [email protected] 2 points 6 months ago (1 children)

So you are saying he's the person who is a candidate to be laid off so that they can find the money to pay their workers more?

[–] [email protected] 1 points 6 months ago

No, that's not how associations tend to work in the US. Very likely he came from an association in an adjacent field and is essentially the conduit to Leadership and in charge of executing their strategic plan and such. He is not paid by the companies is individuals directly he is paid by the association. If they don't do well collectively he is probably out and would be working somewhere else potentially entirely unrelated.

In associations longtime professionals tend to work with the same sorts of groups, but very often their jobs and those of the Members are entirely unrelated and the specialization is more due to connections and being able to say you understand how to work with those sorts of people.

For example I have been working mostly with research scientists most of my career at at this point. I have no background in science, but I have a lot of contacts with people who work for scientific associations and I can say that I an very used to their personalities and have a record of success I can point at. That doesn't mean I couldn't go do a fine job for realtors or something since the jobs would be basically the same, but that I landed here and it's the easiest fit at this point. K

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