Nursing homes were even more understaffed than we knew


Nothing has more to do with how well nursing homes treat their residents than staffing.

Preventing falls and bedsores, properly administering medication, helping patients eat and maintain their dignity — all depend on having enough nurses and aides.

State and federal governments have resisted setting minimum staffing levels, but the public recently gained more accurate information about patient-staff ratios, thanks to a provision of the Affordable Care Act. The news is not good.

The Nursing Home Compare website was updated July 25, based on daily payroll records. Before, Medicare rated staffing levels based on unverified self-reporting by nursing homes, which sometimes beefed up staff during the reporting periods.

Based on the more complete information, Medicare lowered its ratings for staffing in 1 out of 11 of the nation’s nursing homes. Most nursing homes had fewer nurses and aides than they had been reporting to the federal government for years, according to an analysis by Kaiser Health News.

Medicare awarded just one of five possible stars to 1,387 out of 15,616 skilled nursing facilities, Kaiser reports.

Medicare requires that nursing homes have a registered nurse, who is trained to supervise other nurses and aides, on duty at least eight hours every day. Medicare lowered the staffing ratings when homes failed to meet the requirement for having a registered nurse for “a high number of days” or failed to provide payroll data proving the nursing requirement was met.

According to Kaiser’s analysis of the payroll data, for-profit nursing homes averaged 16 percent fewer staff than did nonprofits, even after accounting for differences in patients’ needs. The payroll data may not reflect salaried, as opposed to hourly, staff, especially if they were working overtime. “The biggest difference was in the number of registered nurses: At the average nonprofit, there was one RN for every 28 residents, but at the average for-profit, there was only one RN for every 43 residents. Researchers have repeatedly found lower staffing in for-profit facilities, which make up 70 percent of the industry.”

The data also reveal large fluctuations in staffing from day to day, with especially sparse staffing on weekends, Kaiser reported.

The ACA, enacted in 2010, required Medicare to begin collecting and publishing daily payroll records to gain a more accurate picture of staffing levels.

Families, searching for nursing facilities for loved ones, have another tool, thanks to the more accurate staffing data. But until nursing homes offer their employees competitive pay, families still may have a hard time finding the quality of care our elderly and infirm neighbors deserve.