As many as two-thirds of Maine’s 200-plus nursing homes will need to increase staffing to comply with new federal mandates announced by the Biden Administration. However, many nursing homes are already dealing with severe staffing shortages that predate the pandemic and have only worsened since. According to Angela Westhoff, president and CEO of the Maine Health Care Association, the staffing mandate is unrealistic in light of the historic and deepening caregiver shortage, and more nursing homes are at risk of downsizing or closing. Maine has already lost 25 nursing homes since 2014, and this mandate is unfunded. Others, like Brenda Gallant, executive director of the nonprofit Maine Long-Term Care Program, believe the mandate is a positive step because staffing is the single most important issue for providers. It directly relates to the quality of care and quality of life for residents, as well as the workers providing care. On Monday, the Biden administration released final rules that require nursing homes to have minimum staffing levels, including having a registered nurse on site 24/7. Staffing emerged as a significant problem nationwide during the prolonged COVID-19 pandemic when many caregivers left due to burnout. In some states, including Maine, facilities have filled the worker gap with temporary or traveling nurses, which can be expensive. Another federal rule finalized this week requires facilities that receive Medicaid funding to spend at least 80% on paying workers, rather than on administrative or overhead costs. Current law only requires nursing homes to have “sufficient” staffing, but states have leeway to interpret what that means. Maine has state mandates for CNAs but not for nurses. Gallant believes these minimums have served Maine well but emphasizes that they are just the floor, and every facility needs to consider its own needs. Maine lawmakers debated a bill this legislative session that would have set mandatory staffing levels for nurses at all health care facilities, including nursing homes, a measure that divided many in the industry. While the bill passed the Senate, the House did not take it up before adjourning last week. Nursing home owners in urban areas will have two years to comply with the new federal rules, while rural operators will have three years. This means Maine might have to address the anticipated new costs in the next state budget. However, staffing shortages have been a major issue for years. At the city-run Barron Center in Portland, there were as many as 80 open positions in May 2022, 61 of which were for direct care nurses. The Maine Health Care Association estimates that the state’s nursing homes and assisted living facilities are nearly $100 million in the red, primarily because they are not compensated at a high enough rate for MaineCare recipients. The state has made periodic one-time payments to cover the shortfall, but it continues to grow. As Maine is among the oldest states, the need for nursing home care is only going to increase, and without sufficient beds, the burden on families or on older residents to stay in their homes will also increase. The supplemental budget signed by Gov. Janet Mills this week includes $82 million to help implement a new rate structure for nursing homes beginning in 2025. According to information provided by Mills’ office, the new rate approach emphasizes sufficiency and stability of direct care staff and builds into the rates wages for nurses, CNAs, and others that are in the top 25% of wages paid for those professions in Maine. Westhoff states that these funds will help cover more of the allowable costs of providing care to Maine’s oldest and most vulnerable adults as there is a significant shortfall between the cost of providing care and the MaineCare reimbursement. This shortfall continues to grow because rates are too low to cover the cost of care, including exploding labor costs. Funding in the supplemental budget signed this week by Mills includes $26 million for nursing homes to help cover losses, although some lawmakers advocated for more. Sen. Rick Bennett (R-Oxford) proposed an amendment to a storm relief bill that would have added $31 million more for nursing homes. While this funding may not help the nursing home that is closing in my district, I hope we can prevent more from closing in the future, said Senate Republican Leader Trey Stewart (R-Aroostook). Additional spending was endorsed by lawmakers but not by the governor, who threatened a veto if the storm relief bill was changed.
Maine Nursing Homes Face Staffing Mandates Amid Ongoing Shortages
