COLUMBIA — Attorney General Alan Wilson is challenging a new federal rule requiring increased staffing at nursing homes, arguing that changes intended to improve the quality of care could actually add more pressure to states already struggling with shortages. nursing care.

The lawsuit, filed jointly with 19 other states in U.S. District Court in Iowa, alleges that an April rule implemented by the Centers for Medicare and Medicaid Services to increase minimum staffing levels in nursing homes retirement would present a significant threat to long-term care facilities. ability to function.

In South Carolina alone, critics estimate the rule could cost most long-term care facilities an average of $550,818 in compliance costs — a burden they say will lead to widespread closures.

“This final rule not only represents yet another attempt by the Biden-Harris Administration to impose its policy preferences on the rest of the country, but it is also extremely costly and nearly impossible to comply with,” the lawsuit says.

“Financial pressure, along with inadequate Medicaid reimbursement rates, threatens closure of many long-term care facilities, particularly in rural communities with low operating margins,” the filing adds.

The rule, implemented in the wake of the COVID-19 pandemic, was initially intended to address well-documented concerns about substandard living conditions, unsupervised residents and poor patient care nationwide.

South Carolina appears to be one of the jurisdictions most in need of intervention. In 2023, the state ranked 49th out of 50 in long-term care in rankings published by AARP. Of the 189 nursing homes operating in South Carolina, 75 were recently classified for “severe deficiencies” by the federal Department of Health and Human Services, according to a database maintained by the nonprofit news organization lucrative ProPublica.

Staffing appeared to be the main cause of the system’s problems nationwide.

Under the newly implemented rule, all providers must provide 3.48 hours of direct nursing care per patient per day and employ a registered nurse 24 hours a day. The new standards also require an average of 0.55 nurses authorized and 2.45 certified nursing assistants per patient per day.

Nursing home providers say the standards are too onerous and potentially threaten already threadbare bottom lines, which could lead to increased costs for patients.

If left intact, critics argue the rule could put smaller, nonprofit nursing homes at the greatest risk, potentially depriving smaller, more rural communities of their already scarce long-term care offerings at a time when the state already suffers from nursing shortages.

The federal Health Resources and Services Administration has already projected that South Carolina will be on track to be short some 13,000 nurses by 2036 to meet its needs. Today, the state has about as many vacancies for registered nurses and certified nursing assistants, making the federal rules a standard that many say is unrealistic.

“There’s just a numbers problem here,” said Kassie South, president and CEO of the religious nonprofit LeadingAge South Carolina, a plaintiff in the suit. “We do not have enough staff to fulfill this mandate, which will result in the closure – and has already closed – of services within our state.”

One provider in the state has already increased its pay rates by 20 percent, a cost that South says is ultimately passed on to patients and their families.

Wesley Commons, a LeadingAge facility in Greenwood, chose to increase its pay rates to train and recruit enough employees to fulfill its mandate, costing the facility an additional $164,428 per year. South Carolina Baptist Aging Ministries would have had to pay staffing agencies an additional $500,000 in advance to comply, the lawsuit says.

Others, South said, are considering decertifying some of their beds to meet the mandate — a major concern in a rapidly aging state that has fewer than 20,000 long-term beds in the entire system.

If that happens, South said, the repercussions will be felt not only in the state’s hospitals, but also in homes, as people struggle to find caregivers at home.

Across the state, efforts have already been made to improve the quality of South Carolina’s nursing home system. But they are much easier to respect.

Under a current budget provision, state licensing standards, which are separate from federal standards, require nursing homes to have one registered nurse on duty at all times and to provide a minimum of 1 .63 hours of direct care per resident per day from dismissal. -licensed nursing staff, about half of what the new federal standards require.

Today, most nursing homes in the state are able to comply with the new federal standards, AARP national spokeswoman Madison Daniels wrote in an email.

Overall, data from the Centers for Medicare and Medicaid Services shows that South Carolina nursing homes exceed CMS’s upcoming federal staffing requirements for two of three measurable standards, including the new requirement of 0, 55 registered nurse hours per resident per day and the total of 3.48 hours of nursing care per resident per day. The state’s average number of nursing assistant hours, at 2.25 per resident per day, is only slightly below the minimum safe staffing threshold of 2.45 hours set by CMS.

Before the rule change, long-term care costs in South Carolina had actually declined during the COVID-19 pandemic, according to data compiled by life insurance company GenWorth, while the overall cost of care is currently below the national average, according to the AARP.

The problem is that performance is not universal, particularly in terms of staffing.

“The state is showing that staffing problems are not systemic,” Daniels wrote. “Some nursing homes meet all three CMS staffing standards, while others do not, suggesting that workforce availability is not the primary barrier to achieving safe and consistent staffing. »