Perspectives From Capitol Hill: Mark Parkinson on the Long-Term Care Landscape

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Excelas had the opportunity to hear Mark Parkinson, President and CEO of AHCA/NCAL, discuss trends in the industry in a webinar on April 16, 2024.  Mr. Parkinson reviewed the top regulatory developments affecting providers, implications of the staffing mandate, and trends shaping the industry.


Business recovery post-pandemic has been slow but steady with occupancies recovering by about 3% every year.  The current average occupancy rate is 79%, and it is estimated that this rate will continue to grow to 82% by the end of 2025.  However, nursing homes still need 124,200 workers to return to pre-pandemic levels.  Nursing homes, which suffered the most in job loss of any health care sector, have only recouped about half of the workers lost during the pandemic.


Mr. Parkinson discussed the minimum staffing rule proposed by the Biden Administration [Final Rule released April 22, 2024].  AHCA is not against more staffing, but does oppose a policy that is unfunded and not possible to implement due to the nationwide nursing shortage.  To meet the requirements of the rule, providers would need to hire 105,000 new nurses.  He noted that there is opposition in Congress to the minimum staffing rule, and the November elections could potentially bring a reversal to the rule.

The aging population is increasing, while the overall population growth is declining, resulting in fewer workers to care for the huge number of older individuals.  Mr. Parkinson emphasized that providers for seniors must become world-class employers and focus on employee engagement and satisfaction. This includes mechanisms to care for more residents with fewer workers.


The 2025 Medicare payment proposed rule is favorable with a 4.1% increase in October 2024 and $90,000 per year for the average building.  AHCA continues to work with states on Medicaid funding.  The majority of residents are now under Medicare Advantage and traditional Medicare enrollment is decreasing.  Provider owned networks are now available in nine states and expanding.  AHCA also works with population health management, such as I-SNP (Institutional Special Needs Plan) and ACO REACH (Accountable Care Organization Realizing Equity, Access and Community Health).

AHCA/NCAL provides excellent resources and advocacy for long-term care providers.  After this webinar was presented, Mr. Parkinson released a statement in regard to the Staffing Mandate Final Rule.  In part the statement reads, “While it may be well intentioned, the federal staffing mandate is an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors’ access to care.”

Excelas closely follows the staffing situation in long-term care and continues to enhance tools to assist in the defense of cases alleging inadequate care due to staffing.  To quickly assess the workforce status, Excelas’ clients utilize the Staffing Scorecard, the Provider of Care Report and the Care Calendar/TouchChart.  Contact Excelas today for a demonstration of these powerful tools.

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