By NextBestFitHardship waivers for shortage areas
Facilities that prove they can't hire get time-limited waivers.
Time-limited waivers for shortage areas.
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This path
Hardship waivers for shortage areas
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Allow time-limited hardship waivers
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Staffing mandates raise costs and may close facilities
Time-limited waivers for facilities that prove they cannot hire provide flexibility and prevent closures.
What it creates or worsens
- Requires difficult enforcement
Temporary staffing waivers can become permanent rather than ending as intended.
- Racial, income, and geographic disparities
Giving some facilities staffing waivers leaves patients with unequal protections.
Who's affected
Who gains
- Hospitals, clinics, and care organizations
- Staffing mandates raise costs and may close facilities: Hiring shortages and staffing mandates may force beds or facilities to close.
- Racial, income, and geographic disparities: They can select better-paying patients over those with lower-paying coverage.
- Residents of areas with too few health professionals
- Staffing mandates raise costs and may close facilities: Bed and facility closures reduce local care access.
Who loses
- Health care staffing agencies
- Staffing mandates raise costs and may close facilities: Hiring requirements create demand for agency staff.
- Older and disabled people needing long-term care
- Requires difficult enforcement: Temporary staffing waivers can become permanent rather than ending as intended.
- Black, Hispanic, and Native communities
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
- Rural residents
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
- Low- and middle-income households
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
Where it has been tried
- U.S. 2024 nursing home rule: Included hardship exemptions.
- United States: The 2024 federal nursing home rule mandated 3.48 nurse hours per resident day (including 0.55 RN hours) while offering hardship exemptions for facilities in shortage areas making good-faith hiring efforts (2024).Sources: Federal Register (2024)