- cross-posted to:
- politics@sh.itjust.works
- cross-posted to:
- politics@sh.itjust.works
The Biden administration finalized on Monday the first-ever minimum staffing rule at nursing homes, Vice President Kamala Harris announced.
The controversial mandate requires that all nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift, according to a White House fact sheet.
Plus, nursing homes must have a registered nurse onsite at all times. The mandate will be phased in, with rural communities having longer timeframes, and temporary exemptions will be available for facilities in areas with workforce shortages that demonstrate a good faith effort to hire.
The rule, which was first proposed in September and initially called for at least three hours of daily nursing care per resident, is aimed at addressing nursing homes that are chronically understaffed, which can lead to sub-standard or unsafe care, the White House said.
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The controversial mandate
I wonder what the controversy is…
Nursing home operators strongly objected to the minimum staffing proposal in September, saying they already struggle to fill open positions. Such a requirement could force some facilities to close.
Oh, of course, they don’t want to pay people. These business owners should go back to econ 101, the labour market is just another market. If you can’t get enough people at current prices, you need to PAY MORE.
Mark Parkinson, CEO of the American Health Care Association, said in a statement Monday. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis.”
Oh, it’s funded. Two steps. Grab your wallet, Mark. Look in your wallet. There is your funding.
The proposed staffing mandate has also split Congress, whose approval is not required. A bipartisan Senate bill and similar legislation introduced by House Republicans would prohibit the Department of Health and Human Services from finalizing the rule.
The only time you can reliably expect the US Congress to actually do anything for their fat paychecks is when it has to prevent other people in government to do their jobs.
Every point you made is legit, but just like psychiatric hospitals and asylums of yore, the statement you quoted is a threat that they (the profit-based company) will just stop operating certain locations if people (or the government) don’t pay up. They will literally leave the elderly in the front parking lot and shut the place down if they can’t keep their profit margins is what I’m reading into that statement.
For those unaware, I’m referring to the Reagan administration coming down hard on discontinuing the funding for a lot of government funded psychiatric and elderly care facilities in the 80’s. You can read the Wikipedia article, but it doesn’t really address the insane power these awful and privately operated companies hold over an entire segment of the population in this country, and hold tax dollars as ransom “or else”.
That man in that quote is making a thinly veiled threat to repeat this shit again.
There’s a difference. Psychiatric facilities struggle with funding, nursing homes ABSOLUTELY do not. Have you seen the cost of living in even the shittiest nursing homes? It’s common practice to be paying upwards of $10,000 per month, per resident. Nursing homes have all the money they could ever want, they’re just greedy fucks who purposely utilize dangerously understaffed facilities to maximize profit for those at the top.
They were lumped together in the Reagan administration culling payments for all times of those though. There are few protections for the elderly even still. You don’t need to dig deep and find a zillion hits about these companies raising care rates out of nowhere to vacate tenants. It’s absolutely insane, and there should be laws against it top to bottom.
Plenty of states it’s much higher, in Minnesota the rate is set by the state according to patient need. It’s not unheard of to pay $15k a month as $14k month is the average cost per resident.
To aid in contextualizing this they are being asked to spend at least $2,500 of the $14,000 on labor which isn’t remotely unreasonable
Yep, and they pay CNAs subhuman wages so they’re staffed by anyone who can pass a piss test. (My local gas station sells “fetish urine” lol).
My boyfriend had to put in some hours at a long term care facility as part of nursing school. Absolutely disgusting stuff happens there - the CNAs do not give a fuck (which makes sense, it’s not like you’re making that much better than Macca’s)
$120K per year per resident isn’t that much revenue to cover 24 hour availability of care, food, lease, etc.
I’m not saying it is unworkable, but with the requirement for 3.5 hours of nurse care or resident per day, that means the maximum total cost of a Nurse is $95 per hour, or about $190K.
That really isn’t much - typically employees cost a business twice their base salary. So the nurses can be paid $100K per year while leaving almost $0 for any other expenses…
How are you getting $95 an hour?
3.5 hours of nurse care per resident per day (from the bill).
Resident pays $120K per year to stay at the facility.
There are 365*3.5 hours in a year they need nursing care = 1277 hours of nursing care per year per client.
$120K per year / 1277 hours per year = $94/ hr maximum cost for each nurse - assuming there are no other expenses for the facility.
Must have mistyped to get $95, but that is the math.
Okay, now I understand what you meant by maximum cost. It should be noted that the nurses will likely be paid closer to $30 / hour, give or take depending on the area.
The $94/hr isn’t a salary, it’s the cost to the business. Employees generally cost a business 1.3-1.5X their salary - since insurance, payroll taxes, PTO, etc. all also need to be paid for.
Again this is not considering any other cost for the facility: utilities, food, other staff, medical equipment, maintenance, insurance, rent…
Their asshole
Most of that labor can be filled by nurses aids which make on average $17 an hour not $90
Mark Parkinson is a trash human being. Let his name forever be dragged through shit in search engines.
Chances are that Mark Patterson is not a medical service provider. I am sure he is very well compensated, but he would be association staff, not industry.
So you are saying he’s the person who is a candidate to be laid off so that they can find the money to pay their workers more?
No, that’s not how associations tend to work in the US. Very likely he came from an association in an adjacent field and is essentially the conduit to Leadership and in charge of executing their strategic plan and such. He is not paid by the companies is individuals directly he is paid by the association. If they don’t do well collectively he is probably out and would be working somewhere else potentially entirely unrelated.
In associations longtime professionals tend to work with the same sorts of groups, but very often their jobs and those of the Members are entirely unrelated and the specialization is more due to connections and being able to say you understand how to work with those sorts of people.
For example I have been working mostly with research scientists most of my career at at this point. I have no background in science, but I have a lot of contacts with people who work for scientific associations and I can say that I an very used to their personalities and have a record of success I can point at. That doesn’t mean I couldn’t go do a fine job for realtors or something since the jobs would be basically the same, but that I landed here and it’s the easiest fit at this point. K
Oh, of course, they don’t want to pay people
Even if they could…
Were like 3 years deep into a nationwide nursing shortage and even hospitals can’t get staffed up.
Biden is “creating jobs” that we literally don’t have qualified people to fill.
Which is going to lead to lots of nursing homes being forced to close, and shitty nurses always having a place to land somewhere.
You know what would help?
If Biden had fixed our student loan shit show so more people are able to afford to be nurses.
Like most of the headlines about Biden, it only sounds good if you don’t think further than the headline.
Down the road this causes more problems than it’ll fix.
Shortage? No such thing as a labor shortage. Humans are not scarce.
Pay more, and workers will follow. If they do not follow, then it’s not worth it to them. Make it worthwhile.
Affordability? I guarantee if you pay enough they’ll be able to afford the profession!
Pay enough and staff correctly and the people will come. My wife is an RN. I know directly from her that most places don’t do any of those things and still complain about shortages.
Who knew profit driven medical care was a bad idea /s
We need more of these jobs to have similar paths like blue collar ones. Where you can learn being an apprentice to someone else and take classes on the clock and paid for by the employer. Makes it more accessible for more people and the employer knows how they’re getting trained, and that they’re gonna be ready to work once they’re done.
That’s pretty much how the rest of the federal government works.
At some point you really need a bachelor’s, and again a masters. But you can start entry level and move up.
If we nationalized our healthcare system (like every other 1st world country) you’d likely get your wish. Along with a lot of other things the majority of voters want.
Shortage? No such thing as a labor shortage. Humans are not scarce
They’re not.
But nurses are, have been for years.
It’s not a matter of pay, you can’t just snap your fingers and get a nursing degree…
Affordability? I guarantee if you pay enough they’ll be able to afford the profession!
Just go into tens of thousands of debt, and four years from now after a shit ton of nursing homes close well have plenty of nurses!
Brilliant plan.
What does nursing school cost there? What type of nursing degree is needed to fill the roles that are short? Most nurses here don’t need a multi-year course. The entry level nurse position is a 6 month course. Do elderly care facilities need a higher degree than the entry level? Or does that not exist there? The higher nursing degree is a proper medical degree and of course takes years, but I don’t think that’s the kind of nurses needed for this is it?
What does nursing school cost there?
America?
This works better if you don’t ask 10 questions in a single paragraph bud.
Ideally you’d just Google them tho, would be waaaaay faster.
I don’t think they’re asking questions because they don’t know / can’t find the answer, they’re asking questions to you specifically to try and coax you into thinking critically. It seems that they have failed, but that says more about you than them.
And if they tell me where they’ll asking about, I’ll answer the first one.
But there’s hardly any context, I’d have to ask for clarification for every single question they’re “just asking”.
It’s a time sink, but I’d probably answer a couple if they kept it civil.
And if you think that was the Socratic method…
You might want to read up on it again.
A huge amount of nurses have left the field in the last decade. This has been due to poor wages, poor working conditions, and more pressure on nurses. They all burned out.
During Covid, even when we were all clapping for nurses, instead of giving pay raises they’d rather hire contractors and travel nurses to fill positions because pay raises are permanent. A whole bunch of nurses I know left to do temporary travel, sometimes at the hospital they already worked at. This created huge amounts of resentment and nurses left in droves.
The consolidation of our hospitals and health facilities into the hands of a few small companies is leading to a huge collapse of our healthcare, and it is all their own making.
This all started 30 years ago when hospitals stopped being run by a chief medical officer and a chief nursing officer, and instead began being run by MBAs who only looked at numbers and short term profits. Drs and Nurses have no autonomy anymore and are treated like workers on an assembly line.
Get rid of the MBAs. Break up HCA, Tenant, and the other big chains, require all health facilities to be non profits, and maybe we’ll see people who actually want to work in the medical profession again.
Most of these positions do not require a college degree. They don’t need RN’s- a lot of these positions can be filled by high school kids. My wife and a lot of our friends in high school and college worked these jobs. My neighbor did in-home care for decades with no degree and recently chose to retire early because the pay wasn’t worth staying and she makes more money buying and selling antiques at conventions now.
How many other qualified people have been forced out of the industry due to low wages?
Your comments on Biden seem to indicate You’re either uninformed or purposefully spreading political misinformation. A quick internet search will tell you the Biden administration has forgiven $153 billion in student loans. It would be more if the Supreme Court hasn’t shut down his broader cancellation measures last year.
Is he doing everything he can? Well I’ve seen tons of proposals for other measures to cap the tuition costs or change federal lending, but afaik just about everything would require a bill to be passed by Congress. This may shock you, but Biden can to vote in either the House of Representatives or the Senate so you need to find your own representatives, find their stances, and write to them about this (or anything else you care about).
Unless you have some other proposal I haven’t heard of for executive action that could survive the supreme court?
You’re 100 percent right. My ex went to a short course to be a CNA for one of these facilities, she got paid 3 dollars less than I did. At the time I was a loser high school graduate that delivered packages for fed ex. Now I make 7 dollars more than I did back then, still a loser with just a high school degree and nothing else. I’m a scheduling admin for a company. This wasn’t even that long ago, like 2 years. They get paid criminally low for being in Healthcare.
They don’t need RN’s- a lot of these positions can be filled by high school kids.
Man, the article is right there…
The controversial mandate requires that all nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift, according to a White House fact sheet.
CNA requirement vary by state, but I don’t know any where you don’t need a highschool degree.
Among other things.
https://www.practicalnursing.org/allied-healthcare/certified-nursing-assistant
Reading this and your other comments, you always want to complain about everything and really don’t like Biden.
Did you vote in the 2020 primary?
Yeah, this is quite a “wah the profits!” Kind of an argument from them. I expect them to shit on everything Biden does at this point, but this approach is different.
Are you working to pass electoral reform in your state so people can vote third party with no spoiler effect?
Yes but it’s not going to make a difference for this election.
I’m voting Biden and continuing to work on getting someone younger in the next democratic primaries and working on voting reform.
Why do you ask?
My sister is a nurse. Hospitals are constantly trying to put more and more workload per nurse than is feasible/safe. That sounds like it’s to your point, but it isn’t really. My sister was making like $25 per hour before covid. Her job was to take care of NICU babies. For $25 per hour, with a degree and a fair amount of student loan debt. And they keep adding responsibilities and assume they will work overtime “for the babies”.
Why would anyone want to go to school to get into an underpaid field where literal babies’ lives are constantly in your hands, and the hospital is trying their hardest to decrease their nursing payout by decreasing nursing staff?
We need regulation. Nurses are quitting the field because they cannot handle the stress and the pay certainly isn’t worth it.
That sounds like it’s to your point
My point is we need more nurses.
And the cost of our educational system prevents many from becoming nurses.
trade school should be free and funded by taxes on the businesses it trains for
It’s not controversial if only monied interests say so.
Good for the admin though keep pushing.
I often go to nursing homes for medical calls, and asking for basic patient information is always a treat at the crappier ones.
Pro-tip: when the medic asks you things like “What are we here for?”, “How long have they been having this issue?”, or “What’s their medical history?” you don’t actually have to answer. Just give a blank stare and say “I don’t know, I just started my shift” or “They’re not my patient”. All you have to do is give the ambulance crew the patient’s name and birthday, and even that’s optional.
Is the patient dead and you don’t know when it happened? Say “I was talking to them a few minutes ago!” even if they’re cold to the touch. Bonus points if the pt has a DNR and you don’t give it to the medic.
If all that is too much work, say “I’ll go check” and find somewhere to hide until they leave with the patient – this situation is their problem now.
I work in 911 dispatch, nursing homes are one of the banes of my existence.
Do they have any medical history we should know about?
No.
Oh, I guess they’re just putting perfectly healthy 57 year olds in nursing homes now, good to know.Half of them can’t tell me the address of the damn place they work, which is really nice when they call from their cell phone which barely gets any signal inside the building. Sometimes it’s a crapshoot if they can even tell me the name of the facility
For whole lot of the people who work there, at least at the homes around me, English isn’t their first language, and they don’t speak or understand it very well and speak with a very heavy accent. I’m not knocking them just for that though, they speak more languages than I do, and are clearly trying to make a better life for themselves, I certainly can’t fault them for that, but it does make me a little concerned for their patients. If I, as someone with all of my mental faculties and hearing intact, can barely communicate with you, how effectively can they be treating and supporting patients who often have significant cognitive and/or hearing impairments?
Don’t get me started on the med techs. I’m not any kind of a healthcare professional, so I have only the vaguest idea what their role actually is in a nursing home, but from when they call 911 you would get the impression that they’re kept in a dark soundproof closet until they need someone to call 911, then they’re abruptly yanked out of the closet, spun around a few times, hit over the head with the phone, and told to call 911 while a strobe light flashes in their face, because they never have any idea what’s going on
Now don’t get me wrong, some nursing home staff are great, they have all of the information ready when they call, they’re polite, professional, everything I could hope for, but unfortunately they’re kind of the exception. 90% of the time when I see a call coming in from a nursing home I need to brace myself to deal with someone who is just an absolute mess, disorganized, ill-prepared, unintelligible, uncooperative, sometimes outright rude. Sometimes I consider myself lucky if they don’t just outright hang up on me halfway through the call.
Also some of them love medical jargon, and as I said I’m not a medical professional. They’ll call, rattle off a bunch of stats and vitals that mean nothing to me and aren’t going in my notes even if I could type as fast as they’re spitting them out. When I try to determine what the chief complaint is they’ll spit out something like “their potassium is low,” forcing me to ask for further clarification in plain english, so I know whether to code it as a cardiac thing, a respiratory thing, etc.
Your comment about people who don’t speak English fluently reminded me to take a moment to appreciate that there are a non-zero number of asshole racists who, by nature of being cared for by (at least in some circumstances) people of varied races, do indeed die mad.
That makes me think of my own grandfather (in a good way) I will never claim that he was the most forward-thinking, tolerant, or politically correct person out there, there were a few stereotypes and bits out outdated terminology he never quite shook (for example, the term “colored” never quite left his vocabulary, and he had a tiny bit of lingering distrust of the Japanese having served in the Pacific during WWII)
But for a man who grew up in the time he did, he wasn’t half-bad.
He was never someone who was above holding a a grudge, and he’d gladly tell anyone who would listen who he didn’t like and why. His reasons weren’t always good, he got mad at people over a lot of petty bullshit, but I never heard him disparage someone because of their race. He ended up in a nursing home where a lot of the staff was black, and we never heard a peep from him about their race, he found plenty of other things to complain about, but there was no racial bias to it, he complained about the white employees as much or more than the black ones.
Little bit of fun family history with him, for most of his life he worked as a bus driver. Buses in our part of the country were racially integrated from pretty early on so that was never something he dealt with directly, but he did drive his bus at the same time that bus boycotts and such would have been happening in other parts of the country. He never told us this story himself, we heard it from some other older locals who remembered him driving the bus. There was one particular bus stop that was near a business that employed a lot of black women, and many of them took the bus. The bus would come at around the same time the business closed for the night, so they didn’t have much time to get to the stop before the bus came. A lot of other drivers wouldn’t wait for them, but my grandfather always did, and decades later many of them still remembered him for that.
These are great tips. Can we adapt them to other industries? Maintaining information directly related to your employment is just so difficult and inconvenient at times.
They shouldn’t give exceptions for “good faith effort to hire.” If you can’t hire someone, clearly you aren’t matching what the market demands and need to improve working conditions and pay.
Just like “emergency certifications” in teaching, when the solution to “we don’t have enough qualified people” becomes letting any one with a pulse in, we end up with a race to the bottoms in employee qualifications, pay and working conditions.
You cannot expect someone go through years of school, with additional specialized training, sometimes even masters or doctoral level degrees, to work for substandard wages. In the medical field especially - the mobile and qualified can make bank as travel nurses, why would they bother with you?
If there are too many patients, can that Texas politician’s grandma give up her life for the economy?
(99% positive the politician was from Texas. Pretty this statement wasn’t from Ted Cruz, but maybe. During COVID saying that grandmas in nursing homes would give up their life to open up lockdowns to restore the economy.)
You are thinking of Dan Patrick, he is the Lt. Governor making him the 2nd biggest cunt in Texas right behind Abbot but ahead of Paxton and Cruz. Though, one could argue that the biggest piece of shit stuck to the bottom of Texas’s shoe is Paxton I prefer to lump all 4 in the same bag of dicks.
Thanks.
Yeah, they are just different faces of the same evil.
Isnt a big reason the rail workers had such shitty schedules us because they are understaffed as well?
Correct. They need to strike a hell of a lot harder, and Biden needs to back the union harder. The owners of the rail companies are selfish greedy pigs.
I worked on skilled nursing facilities insurance during the pandemic. Mostly a horror show by owners who don’t GAF about your grandpa and would rather spend money on their personal vehicles than invest in adequate staffing and maintenance. Disgusting group of people.
I’m curious how they came up with 3.48 hours. Does rounding it up to 3.5 really make that much of a difference?
They’re probably working with larger numbers of hours, like in terms of years, and compromises then lower the numbers that later get divided back down into fractional hours.
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At first I was like “wait, how is this controversial?”
FTA:
“Nursing home operators strongly objected to the minimum staffing proposal in September, saying they already struggle to fill open positions. Such a requirement could force some facilities to close.”
There are two options for a nursing home in this position:
- Hire more people.
- Reduce the number of patients.
But here’s the damned part of it… if they shed patients, or just flat out close up shop, all those patients have to go SOMEWHERE and now that’s going to stress OTHER facilities who will need to… yup… hire more or reduce the number of patients.
FTA:
“a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift”
Has anyone done the boomer math here?
https://acl.gov/ltc/basic-needs/how-much-care-will-you-need
"Someone turning age 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years
Women need care longer (3.7 years) than men (2.2 years)
One-third of today’s 65 year-olds may never need long-term care support, but 20 percent will need it for longer than 5 years"
Woof. 76.4 million boomers.
https://www.prb.org/resources/just-how-many-baby-boomers-are-there/
2-3% of that for registered nurses.
10-11% for nurse aides.
2% additional nurse staff.So as much as 15% of the population needed just for nursing staff?
70% of 76.4 million = 53,480,000 boomers needing nursing home care.
15% of 53,480,000 = 8,022,000 nursing staff needed, JUST for the nursing homes.
https://www.aacnnursing.org/news-data/fact-sheets/nursing-workforce-fact-sheet
“Nursing is the nation’s largest healthcare profession, with nearly 4.7 million registered nurses (RNs) nationwide. Of all licensed RNs, 89% are employed in nursing.”
Now that’s just RNs and we only need 2-3% for RNs, but that is still 1,604,400 just dedicated to nursing homes, or about 1/4 of all nurses.
“This statistic shows the number of persons employed in U.S. nursing care facilities from 2000 to 2022. In 2022, there were approximately 1,280,000 persons employed in nursing care facilities all over the United State, a significant decrease compared to previous years.”
Note, that figure is a fraction of what would be needed and that’s ALL nursing home staff, not just the nurses.
This is a great IDEA, and nobody wants nursing home residents living in squalor, but I just don’t see how that mandate is achievable… unless someone puts Boston Dynamics robots through nursing schol…
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Pay higher wages
-
Improve working conditions
The reason they struggle to fill these positions is because of how terrible they treat their front-line staff
That AND there aren’t enough qualified people in the pipeline to fill all the positions that need to be filled.
Labor shortages are always, always, caused by compensation problems or management problems. Every single time. No exceptions.
There are plenty of ex nurses that left the profession during covid. It became abundantly clear how little they were respected. Try respecting them again and maybe you won’t have shortages.
You know the best way to show respect? Proper compensation and competent management.
A nursing program is 16 months. Even if they miraculously started paying more today, the next crop of students isn’t going to see it for almost a year and a half.
That’s the other part of it. You have to attract people to a 16 month commitment before they ever see a salary and there aren’t enough people currently in that pipe at any pay level.
And? Are you claiming if something can’t be fixed tomorrow it’s not worth working on?
No, I’m saying the problem is larger than “well, pay them more.”
No I don’t think it is. It’s just not an instant fix. But nothing in life ever is so that’s a silly way to go about thinking of the world. Besides, there’s nothing to say it would even take years to correct. There’s plenty of nurses that got out of the game due to lack of pay and lack of proper management. Not only would new people get into the profession, but many would come back.
Certainly I think it’s a better solution than continually to underpay them and hoping it’ll work itself out. A pizza party ain’t going to save this shit. There’s no magical scenario to fix underemployment in an industry that doesn’t involve proper compensation.
If they paid enough, there would be more workers entering the pipeline
For 16 months from now, sure. That doesn’t change anything in the interim.
Welp, I guess we’ll just give up then.
Good thing the article stated this doesn’t go into effect immediately.
Raise wages and more people will join the pipeline.
Yes, paying people appropriately really is a silver bullet.
People keep yapping about the wages, meanwhile RNs where I work are taking home $458 per hour. How much more do you propose we offer them, since their pay runs our hospital over $1.25 million per month as is, and they are making more than the general surgeons.
You must be using a lot of travel nurses
There were a lot of positions other than RNs that are disgustingly under paid and over worked, like CNAs.
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Your math is… Difficult to follow, to say the least.
tl;dr We need nurse robots!
15% of 53,480,000 = 8,022,000 nursing staff needed, JUST for the nursing homes.
It seems you’re making the assumption that all these baby boomers will need care in a nursing home at the same time. This doesn’t seem reasonable at all given there’s an 18 year age range among boomers.
Granted it’s not going to happen all at the same time, but when the oldest ones have died off, the oldest GenX’ers (me) will start qualifying.
Regardless if the number is 8 million nurses, 1 million nurses, or something in between, we don’t have enough people working the jobs or in the pipeline to meet this mandate.
