Nursing home staffing ‘dead’ with Trump win, but workforce and wage issues remain

A day after President-elect Donald Trump declared a surprisingly decisive victory, many long-term care stakeholders were looking forward to sweeping policy changes. But some experts warned on Wednesday that Trump’s victory would cut both ways.

Providers hope to capture Trump’s anti-regulatory outlook, reverse the Biden administration’s burdensome new staffing requirements starting in 2026 and dispel existing opposition to for-profit nursing home ownership.

“Certainly, as in other Republican administrations, it would be more advantageous if you own or operate a skilled nursing facility or chain,” said Fred Bentley, managing director of Medicare innovation at ATI Advisory. “Personnel authority expired upon arrival. They will scale back or reduce regulatory reviews and surveys. You can go down a little bit and it will be a more suitable environment.

However, years of work immigration reform The need to expand the long-term care workforce won’t even be up for discussion during the next president’s term, Bentley said McKnight’s Long Term Care News. Also likely gone are tougher rules on Medicare Advantage plans that increasingly deny access to post-acute care.

A win for Trump and Republicans taking back the Senate could give the party a clear path to enact significant changes. The only major questions that remained unanswered late Wednesday afternoon were how big the party’s majority would be in the Senate and whether Republicans would also maintain control of the House of Representatives.

LTC advocacy groups weigh in

Clif Porter, president and CEO of the American Health Care Association/National Center for Assisted Living, said in a statement Tuesday that he welcomed the opportunity to work with Trump.

“It is critical that our nation’s leaders prioritize, support and invest in America’s seniors and their caregivers,” Porter said, calling for quality care and collaboration with Trump and the 119th Congress to address the growing caregiver gap and advocate for the nation’s aging. population.

“While we are eager to get started, there is still much that can be achieved before the end of the year,” Porter added. “We urge lawmakers to introduce legislation during the lame duck session that rationalizes regulations, expands workforce development, and increases access to care for seniors and individuals with disabilities.”

Providers see the lame session, the post-election period that runs from now until Inauguration Day on Jan. 20, as an opportune time to appeal to members who have left Congress for support on issues they have previously avoided. This could also be a chance for those leaving the session to push for reforms that were not previously brought to a vote.

For example, Senator Jon Tester (D-MT) championed legislation to block the Center for Medicare and Medicaid Services’ nursing home staffing rule. He was removed from office on Tuesday, but LTC advocates believe Tester and others could still have major influence over the rule and other bills in the final days of the 118th Congress.

“We are optimistic that the Trump administration will rescind the unrealistic staffing mandate, but there are still many avenues for Congress and the courts to address this issue,” Porter said. McKnight’s. “We will continue to move forward on every front to protect access to care and push for more meaningful workforce solutions.”

Linda Couch, LeadingAge’s senior vice president of policy, said that if there is no foolish activity that would invalidate the staffing order, the Trump administration could decide to suspend the practice and issue a final rule repealing it.

“We see this action as a possibility; “However, we will continue our legal advocacy as long as no institution is abolished,” he said. The McKnights in an email.

Efforts are also underway to understand what the new administration might focus on first and to help place some skilled nursing and other LTC initiatives higher on that priority list.

“In the near term, we will focus on working with Trump transition teams to share LeadingAge’s agenda and clearly understand the new administration’s goals for housing, aging, health and long-term care,” said LeadingAge President and CEO Katie Smith Sloan. He said Wednesday. “As we learn more, we will better understand their potential impact on our members and those they serve – wherever their home is. This is our top priority in the short term.”

previous record

during his first day of presidency In 2017, Trump used a joint chief executive maneuver and ordered a freeze on all pending regulatory actions. This may also be a choice in his second term.

As of Wednesday afternoon, several rules that could impact post-acute care providers were still being reviewed by the White House Office of Management and Budget. These included five CMS rules, including a proposal that would govern policy and technical changes to the Medicare Advantage and PACE programs in 2026. There are six more Labor Department rules pending, including proposed updates to the Fair Labor Standards Act and the finalization of a decision. Rule to limit healthcare personnel exposure to COVID.

Any rules still on this list by mid-January could be permanently frozen, and any rules finalized before then could be subject to Congressional Review.

“If the new administration is serious about regulations and reducing burden, there’s a lot of that in healthcare, too,” Dan Mendelson, CEO of Morgan Health and founder of Avalere Health, wrote on LinkedIn on Wednesday.

It’s unclear whether Trump will go so far as to eliminate Biden-era rules aimed at increasing transparency in nursing home ownership and giving state licensing boards and others better quality information that can be used when evaluating future transactions.

But provider advocates expect Trump to pull back from the rhetoric, creating a much more hospitable environment for health care mergers and acquisitions.

“There was a persecution of President Biden denigrating the nursing home industry,” said Brendan Williams, CEO of the New Hampshire Health Care Association. McKnight’s Wednesday. “President-elect Trump has no such hostility toward the industry, and I expect his administration to roll back Biden’s outlandish regulatory revenge.”

Mendelson said he expects “a more tolerant deal environment and increased deal activity in healthcare.”

One of the biggest determinants of how well Trump can clear merger and acquisition hurdles is who he will appoint to be secretary of the Department of Health and Human Services. The president-elect said onetime Independent candidate and vaccine conspirator Robert F. Kennedy Jr. will have a “big role” in the health care arm of his administration with his influence on food and drug regulations. Trump did not specify whether that would be as an advisor or in a more official capacity.

Williams said he was “very unsure” how Kennedy’s promised role would interact with the post-acute sector, where both its workforce and residents have largely rejected Covid vaccines this fall.

Medicare and MA expectations

Because Trump campaigned on protecting Medicare and the country is aging rapidly, Bentley predicted Trump might address the issue with typical Republican expectations.

“I don’t understand why budget hawks are going after Medicare. “Maybe they will go after Medicaid and try to cut the sails on Medicaid spending, and that could have negative effects,” he said. “But it looks like the tap will be wide open.”

Bentley predicts this will include more favorable reimbursement for Medicare Advantage insurers; Which plans may (or may not) reflect gains in the rates they pay to skilled nursing providers? But Bentley warned that this “cuts a lot of different paths.”

“The extent to which the Biden administration has focused on improving access to skilled nursing care and home health care and mandating MA plans to provide the same access and coverage that Medicare fee-for-service beneficiaries receive has been eliminated or significantly watered down,” Bentley observed.

Big budget questions

Bigger questions about how Trump approaches federal budget negotiations could also seriously impact the industry. Congress must pass another short-term government funding bill in December to avoid a shutdown.

“There is motivation from both sides of the aisle to prevent a government shutdown. Budget concerns are legitimate for health care providers as well as all industries,” added Melissa Schakowsky, director of government affairs for the Ambassadors Group, an advocacy organization for long-term care providers. “I wonder how bold conservatives are about cutting government spending, especially for entitlement programs It is unknown what will happen.”

The real question, Couch said, is what will happen to the House’s balance of power.

“The response could directly impact Congress’ appetite for and ability to complete FY25 bills, and we are asking them to do so as quickly as possible,” he explained. “Permanent solutions are of no use to programs or agencies, especially long-term CRs. “If all the work of FY25 is rolled over to the next session, these bills could get mixed up with decisions on raising the debt ceiling and other very sticky little issues.”

No matter what happens in the future, all-year budget processes can also mean bad news for patients and providers.

Some Republicans have pushed for across-the-board spending cuts that would reduce health care spending. While some settings may rely on insurance companies and private payments to increase their profits, skilled nursing providers are almost predominantly dependent on Medicare and Medicaid payments.

Trump made an offer to his confidant Elon Musk join the cabinet as “cost reduction secretary”; Musk said he wanted eliminating $2 trillion from the federal budget.

Williams said Wednesday he hopes no Musk proposals emerge that would “hurt Medicaid and Medicare.”