By Steve Moran

This is the second article in a three-part series on staffing mandates. Read part 1 here and part 2 here.

This is a powerful and important opportunity for the nursing home industry to take control of their own future and make the lives of residents, team members, family members, and owners and operators better. It is time for the industry to step up to the table, demand change, and propose a new way of doing things that is fair and reasonable to everyone.

With Respect to Mandates

Specifically with respect to mandates, the industry should propose its own set of mandate rules that would follow this format …

We 100% support mandates, and this is what they should look like:

  • There has to be a guarantee that the government will provide adequate funding to pay market-rate wages, knowing that with increased staffing, rates will need to be substantially higher.
  • The mandates have to have enough flexibility to account for different resident population needs.
  • There should be a stipulation they will only happen when there are enough qualified workers.
  • There have to be some safety valves that will protect owners and operators when it is impossible to meet the mandates because of reimbursement and staff availability.
  • There need to be specific protections for rural-community nursing homes.

Beyond Staffing

The government’s staffing mandates proposal is only the latest in a long, ugly string of ineptly conceived rules that have done little or nothing to improve the resident or employee experience. Just one for instance, the idea that bigger, more draconian fines, often imposed unevenly and irrationally, will make nursing homes better has proven to be one of the dumbest ideas the government has ever come up with.

Instead of improving care, they force litigation, which hurts staffing and hurts care of residents.

It is time for the industry to start with a clean sheet of paper and propose a new regulatory and reimbursement framework that is detailed and practical.

While both AHCA and LeadingAge have produced content that includes a new conceptual framework, relying on the government to do the heavy lifting leaves the industry in a massively vulnerable position.

Proposing this framework will be hard because it will hurt the ownership of the worst facilities. It will hurt the cash flow of some vendors who are more interested in money than quality. That does not mean it is not a worthy cause.


Everyone in the whole country knows the current nursing home system is broken. Only the industry can possibly come up with a plan to make it right. Trying times create great opportunities. The only question is this: Will we seize the moment?