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In a bold move that reverberates through the corridors of care, Indiana is stepping into the ring alongside 19 other states in a multi-state lawsuit aimed at halting a controversial federal mandate aimed at increasing staffing levels in nursing homes. Led by Indiana Attorney General Todd Rokita, this coalition of Republican attorneys general is raising concerns that the new rule could jeopardize the very institutions tasked with caring for some of our most vulnerable citizens.

The lawsuit, a detailed 66-page document filed on Tuesday, paints a grim picture of the implications posed by the new regulations from the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services. “Although the nursing home industry certainly has had its share of challenges, it fills a vital need in our communities that cannot be replaced,” the filing asserts, emphasizing the potential for widespread closures of facilities already on shaky ground.

This federal rule, introduced in response to the devastating effects of COVID-19 on long-term care facilities, mandates nationwide staffing standards, including requirements for having a registered nurse on-site 24/7. Such changes are rooted in the need to address safety and health concerns that were glaringly exposed during the pandemic, where many nursing homes faced significant challenges due to inadequate staffing.

As it stands, many nursing homes are ill-equipped to meet these new demands. The final rule, established in April, includes requirements that would necessitate a staggering increase in nursing staff: facilities would be required to provide residents with a minimum of 0.55 hours of care from a registered nurse daily and 2.45 hours from a nursing aide. Under current regulations, a registered nurse is only required to be present for eight hours a day, seven days a week.

According to a report by the Kaiser Family Foundation, the implications of this rule are far-reaching. It’s projected that over 100,000 full-time positions would need to be filled, at an estimated cost of $6.8 billion annually. Shockingly, the lawsuit claims that 94% of nursing homes could struggle to meet at least one of the three requirements, putting the well-being of hundreds of thousands of residents at risk.

The financial implications for Indiana are particularly alarming. Should the state be compelled to implement the rule's demands, estimates suggest facility costs could surge by $10.9 million if a registered nurse is required to be on-site around the clock. Overall compliance costs could skyrocket to as much as $151.2 million.

The nursing home industry is already grappling with significant staffing shortages, a situation exacerbated by the pandemic. Many healthcare professionals have been slow to return, and families of residents continue to voice their concerns over staffing levels. In fact, while some believe the federal rule doesn’t go far enough in ensuring quality care, many in the industry argue that the new regulations could further strain already stretched resources.

The Indiana Health Care Association and LeadingAge Indiana, key players in advocating for nursing home interests, have not joined the lawsuit but have expressed apprehension regarding the potential impact of the mandate on their members.

Moreover, the lawsuit argues that the federal agencies may have overstepped their bounds, claiming the previous staffing standards were set by Congress and questioning whether stricter regulations would genuinely enhance resident care. It criticizes the “one-size-fits-all” approach of the new rules, suggesting it fails to account for the ongoing workforce shortages that nursing homes face.

As the narrative unfolds, one thing is clear: the future of nursing homes in Indiana and beyond hangs in the balance. With an aging population—one in five Hoosiers will be retirement age or older by 2030—the need for innovative solutions and flexible policies has never been more urgent.