ICYMI: AHCA/NCAL and National Association of Licensed Practical Nurses Lead Joint Comment Letter Requesting CMS Withdraw Federal Staffing Mandate

Comment Letter Underscores Mandate’s Flawed Approach, As Licensed Practical Nurses Fail To Be Recognized As Nurses

Advocacy; Workforce

Washington, D.C. – The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the National Association of Licensed Practical Nurses (NALPN) joined seven other leading nursing and long term care organizations in sending a joint comment letter to the Centers for Medicare and Medicaid Services (CMS) to urge the agency to rescind its proposed federal staffing mandate. The comment letter was among more than 46,000 comments CMS received during the 60-day comment period.

The one-size-fits-all mandate proposes that nursing homes provide residents with a minimum number of hours of care from a registered nurse (RN) and from a nurse aide per day, but excludes LPNs who are critical members of the care team. LPNs make up 13 percent of the nursing home workforce, with more than 170,000 working in nursing homes today. The groups ask CMS to withdraw the rule altogether, highlighting how the exclusion of LPNs is yet another example of its fundamental flaws. In the comment letter, the groups write:

“LPNs work in tandem with registered nurses (RNs), nurse aides, and other staff to deliver high-quality care to residents. It is evident that LPNs are essential members of a coordinated care team, yet the proposed federal staffing mandate gives absolutely zero credit to the vital role they play as licensed nurses. To not include LPNs with RNs is an affront to their hard work and dedication to the residents they serve.

“As currently proposed, this blanket mandate not only sends the message that LPNs are not as important as other licensed nurses, but it also discourages certified nursing assistants (CNAs) who are looking for more care advancement opportunities. The exclusion of counting LPNs with RNs demonstrates just how deeply flawed this proposal is. More importantly though, a one-size-fits-all staffing mandate such as the proposed hours per resident day (HPRD) is a simplistic, outdated approach that does not consider the interprofessional collaboration model nor the need to make staffing decisions based on each unique resident and their care plans.

“We are requesting the Administration to withdraw this archaic, unfunded health care policy and instead focus on meaningful, supportive ways to grow and retain the nursing home workforce. At the same time, LPNs should be recognized and regarded with RNs as nurses—that’s what they are. This means any RN requirement should include all worked hours of LPNs in it, as both are licensed nurses. These are integral and valued members of our nursing homes, and they should be treated as such.”

The proposed CMS rule is unfounded in its approach, as the agency’s own commissioned study found that no level of staffing guarantees quality care. If CMS finalizes the mandate despite this, it calls into question how ignoring hundreds of thousands of care professionals that contribute to resident care would somehow accomplish the rule’s intended goal.

Further, a recent analysis found that the federal staffing rule threatens the displacement of nearly 300,000 residents. Nursing homes that are unable to meet the requirement because they can’t hire the number of necessary RNs and nurse aides will have to limit their admissions or close altogether, further limiting access to care for vulnerable seniors.

To improve quality of care, the Biden Administration and federal lawmakers should instead focus on supportive policies and programs that will actually help nursing homes build a strong pipeline of caregivers. A one-size-fits-all mandate that does not even recognize all of the essential caregivers who contribute to resident care is entirely the wrong approach. 

The American Assisted Living Nurses Association (AALNA), Association of Jewish Aging Services (AJAS), Lambda Psu Nu Sorority Inc., LeadingAge, National Alliance of Wound Care and Ostomy (NAWCO), National Association of State Veterans Homes (NASVH) and the National Rural Health Association (NRHA) also signed the letter.

Read the full comment letter HERE.