Are Nursing Homes Understaffed?

In 2010, Congress enacted the Patient Protection and Affordable Care Act (the “ACA” for short, but more popularly known as “Obamacare”). The ACA made some well-publicized changes to the American health-insurance market, but it also made many smaller changes that have gradually started to have an impact over the last few years.

One of those changes was to the way that nursing homes report their staffing levels to the federal Centers for Medicare and Medicaid Services (CMS). Previously, nursing homes had simply self-reported staffing based on the number of workers present in the weeks leading up to a government inspection.

But now, under the ACA, nursing homes must submit daily payroll records to CMS quarterly. Those records provide a much clearer picture of a nursing home’s staff and how it changes over time. Thanks to this new method of reporting, industry analysts have been able to better gauge the real level of staffing at the nation’s nursing homes, and CMS has been able to adjust the quality scores it reports to the public.

Analysts’ Findings from New Payroll Records

In early July, the New York Times reported on an analysis of the new payroll-record submissions conducted by Kaiser Health News (KHN). KHN’s review of those submissions revealed several surprising facts, including:

  • Most nursing homes had inflated their staffing levels under the old reporting system.
  • Staffing levels varied dramatically between weekdays and weekends.
  • On average, on weekdays, there were between 18 and 30 patients for each nurse working, and between 9 and 14 patients for each aide.
  • On weekends, those numbers jumped to 20 to 38 patients per nurse and 10 to 17 patients per aide.

These discrepancies can result in longer waits for patients who need help, such as help going to the bathroom or, for bedridden patients, being turned to avoid bedsores. As one patient told KHN, at times nursing homes can seem “like a ghost town.”

Changes to Staffing Quality Scores

CMS operates a website called Nursing Home Compare that can be helpful in choosing the right nursing home for yourself or your loved one. That website rates nursing homes throughout the country based on health inspections, staffing levels, and 16 physical and clinical quality measures.

In response to the new details uncovered through its payroll-reporting system (or because some nursing homes failed to submit their information on time), in late July CMS cut staffing ratings to the lowest possible score for almost 10% of all nursing homes in the country. So, if you haven’t looked at the Nursing Home Compare website in the last few months, you may want to do so again.

Then, at the end of August, the inspector general of the Department of Health and Human Services (the cabinet-level agency of which CMS is a part) announced that he would be investigating staffing levels and CMS’ efforts to obtain accurate information over the next two years. In other words, we haven’t heard the last of this story.

What Does This Mean for California?

The New York Times’ first article on nursing home staffing includes a link to a helpful interactive map showing how staffing at nursing homes around the country compares to the national average. Fortunately, here in Petaluma, the nursing homes tend to have above-average staffing levels. But in neighboring areas, you can see more variation, with a handful much below the national average.

All this emphasizes two points about finding a nursing home for yourself or your loved one:

  • First, do your homework: Use the online resources that are available (including Nursing Home Compare) to get a rough idea of how the nursing homes you are considering compare to others.
  • Second, do some field work: Go to those nursing homes and look at how well they are staffed when you visit. Go more than once, on different days and at different times of day.

And remember, if you need help paying for nursing home care, Long-Term Medi-Cal may be an option. To learn more about Long-Term Medi-Cal and how you can qualify, contact the Law Office of Bridget Mackay to schedule a consultation.

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