As many as two-thirds of Maine’s 80-plus nursing homes will have to hire workers to comply with new staffing mandates announced this week by the Biden administration, according to the state’s top health care lobbying group.
And many already are dealing with unprecedented staffing shortages that predate the pandemic and have only worsened since.
“This staffing mandate is unrealistic in light of the historic and deepening caregiver shortage and more nursing homes are at risk of downsizing or having to close,” said Angela Westhoff, president and CEO of the Maine Health Care Association. “Maine has already lost 25 nursing homes since 2014. Further, this is an unfunded mandate.”
Birch Shambaugh, owner of Woodford Food & Beverage, delivers burgers to the staff at Portland’s Barron Center in December 2020. Shambaugh delivered meals to front-line health care workers as part of the Feeding the Frontlines campaign throughout the pandemic. Brianna Soukup/Staff Photographer
Others, however, say the mandate is a good step because staffing is the single-most important issue for providers.
“It’s directly related to quality of care and quality of life for residents, but also to the workers who are providing care,” said Brenda Gallant, executive director of the nonprofit Maine Long-Term Care Program. “They choose this work because they want to make a difference and it’s discouraging when staffing isn’t at the proper level.”
On Monday, the Biden administration released final rules that will require nursing homes to have minimum staffing levels, including having a registered nurse on site 24/7. Staffing emerged as a major problem nationwide during the prolonged COVID-19 pandemic when many health care workers left the field because of burnout. In some states, including Maine, facilities have filled the worker gap with temporary or traveling nurses, which is an expensive solution.
Another federal rule finalized this week requires facilities that receive Medicaid funding to spend at least 80% of that money to pay workers, instead of administrative or overhead costs.
Current law only requires that nursing homes have “sufficient” staffing, but states have leeway to interpret what that means. Maine has state mandates for certified nursing assistants (CNAs) but not for registered nurses, Gallant said.
“I think it has served Maine well to have these minimums in place,” she said. “But remember the minimums are just that, the floor, the baseline. Every facility needs to consider its own needs.”
Maine lawmakers debated a bill this 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. Although the bill passed handily in the Senate, the House never took it up before adjournment 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.
That means Maine might have to deal with the anticipated new costs in the next state budget.
“Even without this ruling, we need more funding, and more certainly for these facilities to exist,” said Sen. Rick Bennett, R-Oxford, who proposed an amendment, which ultimately failed, to an unrelated bill that would have added $31 million for nursing homes.
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 and 61 of them were for direct care nurses.
Already, the Maine Health Care Association has estimated that the state’s nursing homes and assisted-living facilities are in the red by nearly $100 million, largely because they aren’t compensated at a high enough rate for MaineCare recipients, who account for two of every three residents. The state has made periodic one-time payments to cover that shortfall but it continues to grow.
Since Maine is among the oldest states, the need for nursing home care is only going to grow, and without sufficient beds the burden on families or on older residents to stay in their homes will increase, too.
The supplemental budget that Gov. Janet Mills signed this week does include $82 million to help implement a new rate structure for nursing homes beginning in 2025. According to information provided by Mills’ office, the new approach emphasizes sufficiency and stability of direct care staff and builds into the rates wages for RNs, CNAs, and others that are in the top 25% of wages paid for those professions in Maine.
“These funds will help to 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,” Westhoff said. “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 includes $26 million for nursing homes to help cover losses, although some lawmakers advocated for more and say the new ruling could make things even worse.
“This ruling is going to put more stresses, especially on rural facilities. Many are not going to be able to hit the mark,” Bennett said. “This is going to be an issue until it’s solved. Nursing homes aren’t just struggling, they are closing. This is a dire emergency.”
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