The lead lobbying organization for nursing homes wants a sit-down with President Joe Biden and his top health officials to talk about the White House’s plans to more tightly regulate skilled nursing facilities.

Mark Parkinson, president and CEO of the American Health Care Association and the National Center for Assisted Living, wants to meet with Biden, Health and Human Services Secretary Xavier Becerra and Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure, he wrote in a letter to Becerra Tuesday.

“It is crucial that you hear directly from dedicated nursing home operators and professionals about the quality efforts that are already taking place, the successes that SNFs have achieved and our bold plans for the future,” Parkinson wrote. “It is also important that providers share the critical challenges they face in recruiting and retaining healthcare workers and other critical personnel.”

During this State of the Union address last week, Biden highlighted safety and quality shortcomings at nursing homes, along with the severe toll the COVID-19 pandemic has taken on their residents and employees. More than 200,000 patients and workers in long-term care facilities died from the virus, amounting to roughly a quarter of pandemic-related fatalities nationwide, according to CMS data compiled by the Kaiser Family Foundation.

The pandemic presented unprecedented safety and quality challenges to healthcare providers, but years of research shows nursing homes had problems before the public health emergency was announced. For example, regulators uncovered at least one infection prevention and control error at 82% of the nursing homes inspected between 2013 and 2017, the Government Accountability Office reported in 2020.

In regards to staffing, Parkinson wrote that nursing homes want to hire more employees but face major recruitment challengesstarting with a worker shortage.

“Increasing staffing minimums in the midst of this workforce crisis—without corresponding resources—does little to help residents and would result in nearly every nursing home being out of compliance. Facilities, especially in rural communities, would be forced to further limit access to care for residents in order to meet arbitrary staffing ratios or close altogether,” Parkinson wrote.