(The Center Square) — A squabble between Sen. Bob Casey and his Republican challenger Dave McCormick over nursing homes reveals wider problems in the commonwealth’s health care system.
While the focus is on staffing mandates, Pennsylvania health care across the board has worker shortages, funding issues and accessibility problems with which to deal.
McCormick has been critical of Casey’s support for a new federal rule mandating minimum staffing at nursing homes which officials hope will prevent poor-quality care.
Health care groups have called those efforts “harmful mandates for long-term care providers” and argued the rules will require nursing homes to hire another 8,000 workers at a cost of $540 million annually – difficult to do without higher Medicaid reimbursement rates.
“Casey’s had nearly 18 years to address this growing staffing crisis, and instead applauds an unfunded Biden mandate that will make the problem worse,” McCormick said. “As Pennsylvania’s senator, I will fight to expand skills training for critical careers like nursing and invest in rural healthcare.”
The incumbent senator, however, argues that a staffing minimum rule needs to happen as part of a systematic solution.
“For far too long, staffing shortages at nursing homes have meant that seniors in Pennsylvania and around the nation are not getting the high-quality care that they need and deserve,” he said. “We must do everything we can to ensure every nursing home is meeting that high-quality threshold, and that means investing in the workers who care for our seniors and are currently overworked and underpaid.”
He added that “the highest quality care” can’t be provided without more investment into “the caregivers who provide it.”
Casey’s staff downplayed potential negative impacts of the rule, noting that Pennsylvania passed new staffing rules last year. He also sees the staffing minimum rule as part of a broader effort: require more staff in nursing homes and offer more money from the federal government for better pay and worker training.
Casey introduced the Long-Term Care Workforce Support Act in April, which would increase federal Medicaid funding to states, offer $100 billion in grants for long-term care and direct care workers, $500 million annually in grants for workforce training for 2025-2029 and tens of millions of dollars in other areas.
Pennsylvania Sen. John Fetterman also endorses the staffing minimum rule, though almost three dozen Senate Democrats have opposed it alongside Republicans, who warn it could devastate rural areas.
There’s also no guarantee that creating a new staffing rule will spark more government financial support.
“It’s a whole lot easier to mandate requirements than it is to spend money in government,” said Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform in Pittsburgh.
The staffing trouble for rural nursing homes, he argued, breaks in three ways: they can’t attract staff to the area to work; they can’t afford to pay competitive rates; and nursing homes trying to boost profits by keeping staff levels low.
“The nursing home staffing mandate, in a sense, should be trying to address the third issue. If you’re running a nursing home, you shouldn’t be staffing at lower levels than you can afford to,” Miller said. “But that doesn’t solve the problem in the first two cases.”
Rural nursing homes face the same problem as hospitals and other health care facilities: an over-reliance on Medicaid payments means nursing homes can’t pay staff enough to keep or attract them.
“You can mandate that they have staff, but if they can’t afford to pay, then their choice is to go out of business,” Miller said. “The challenge of the staffing mandate is that you have to ensure that you’re not just putting pressure on the facility to do something that it can’t afford to do or can’t find people to do.”
Similar problems have led to the closure of rural maternity wards in Pennsylvania.
Raising state payments isn’t a simple choice, either. Medicaid is a state-federal partnership.
“If the state pays more, the feds will pay part of it, but the state has to pay more of that. And that is a big part of most states’ budgets: Medicaid payments for long-term care,” Miller said. “Pennsylvania’s a state where the workforce problem is more severe. The more old people you have, it’s the young people who take care of the old people.
On a ratio basis, one of the concerns nationally is we’re getting to the point where there’s not enough working-aged people to take care of the people who are older,” he added.
States like Pennsylvania, where the ratio is already lower, will have a harder time dealing with that fiscal problem. But the connection between the rules at play in health care and the cost to meet them is not well-connected.
“The state could say, if our licensing standard requires a facility to have the following kinds of equipment, staffing, and training, what does that cost? Are we paying enough to cover that cost?” Miller said. “That is really not done at all adequately today.”
