Nursing home staffing often thin, inconsistent: 4 key findings

Significant staffing fluctuations exist at nursing homes across the country, and methods of measuring if often mask understaffing, a Kaiser Health News analysis found.

For the analysis, KHN examined daily Medicare payroll records involving more than 14,000 nursing homes. The records represent Medicare's new approach to calculating average staffing ratings at nursing homes, as required by the ACA.

Previously, such evaluations had been based on self-reported data from facilities for the two weeks before CMS conducted inspections, and facilities could boost staff in anticipation, the report said.

Four analysis findings:

1. The analysis found 25 percent of facilities did not report registered nurses at work during October, November and December 2017. Federal officials do not require a minimum resident-to-staff ratio at nursing homes, but they do require facilities to have a registered nurse for eight hours daily and a licensed nurse around the clock, the report states.

2. Seventy percent of nursing homes had lower staffing under the ACA-mandated measurement approach.

3. The average resident-to-nurse ratio on best-staffed weekdays was 18 to 1, compared to 20 to 1 on best-staffed weekends. For worst-staffed weekdays and weekends, those ratios were 30 to 1 and 38 to 1, respectively.

4. There also were fluctuations with aides directly caring for residents on weekends compared to weekdays. On best-staffed weekdays, the resident-to-aide ratio was 9 to 1 compared to 14 to 1 on worst-staffed weekdays. On weekends, those ratios increased to 10 to 1 and 17 to 1, respectively.

In response to the analysis, CMS told KHN in a statement it "is concerned and taking steps to address fluctuations in staffing levels" revealed with new data, and said it would lower ratings for nursing homes that did not have a registered nurse for seven or more days.

Read more about KHN's analysis here.


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