LeadingAge Maryland shares CMS’ goal of ensuring older adults and others have access to high quality skilled nursing care. We have continued to advocate, along with LeadingAge National, that the staffing mandate as written is untenable, given the documented shortage of registered nurses and other nursing professionals in our state and across the country.

As more local LeadingAge State Affiliates joined the lawsuit, it became clear we needed to take advantage of this opportunity to advocate for our members, and for non-member skilled nursing providers. After a vote by the LeadingAge Maryland Board of Directors, we joined the lawsuit in early September.

Not only does this lawsuit seek to overturn the staffing mandate but also seeks to reserve a claim for preliminary injunction. If the injunction is granted, it could stop some of the more onerous staffing mandate requirements for our members while the lawsuit navigates the court system.

The purpose of our joining the suit includes:

• Despite our best efforts to advocate for changes to the Rule, the staffing mandate provisions contain problematic provisions that ultimately could harm Marylander’s access to skilled nursing care.
If a preliminary injunction is granted it could be narrowly tailored, and we want to make sure that at the very least, the onerous requirements will be paused for LeadingAge Maryland members. We continue to advocate that the mandate be paused for all nursing homes, but the likelihood of that outcome is unclear at this time.
• The Rule as written is untenable and unattainable for our members. We estimate the staffing mandate will cost each nursing home in Maryland, on average, an additional $642,000 each year. Collectively, we anticipate that the rule will cost nursing homes in Maryland roughly $142.5 million per year. The Rule contains no additional funding to support nursing homes in addressing these increased costs.
• There are simply not enough registered nurses or nursing assistants to meet this mandate. The cost of implementing the proposed staffing mandate will damage nursing homes. The cost of delivering quality care already far exceeds Medicaid reimbursement, and this unfunded mandate will further jeopardize nonprofit and mission-driven nursing homes’ ability to continue to serve older adults and families—forcing them to consider limiting admissions or even closing.
• Based on recent PBJ data (Payroll Based Journalling data is reported to CMS by every nursing home and is how staffing data is evaluated) we estimate that collectively, nursing homes in Maryland would need to employ 206 more full-time registered nurses, and more than 1,897 full-time nursing assistants to comply with the staffing mandate requirements. Unfortunately, these additional registered nurses and nursing assistants do not exist. According to the Maryland Nursing Workforce Study conducted in 2022, which detailed the shortage in Maryland’s nursing workforce today and into the future, it is estimated that Maryland would need an additional 11,000 registered nurses by 2035 just to keep pace with the growing demand for care in our state. Specifically, it is estimated that by 2035, the state will need an additional 610 registered nurses working in nursing homes alone to keep pace with the growing demand for care. This was before the constraints of the staffing mandate were factored in.
• Life Plan and Continuing Care Retirement Communities have been struggling with staffing since the pandemic. This exacerbates the problem with CMS’ Staffing Mandate. According to a new report from Fitch Ratings, employment at Life Plan/Continuing Care Retirement Communities remains 5.90% below pre-pandemic levels. Skilled nursing facilities have seen a further decline in staffing of 7.27% since February of 2020.