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Nursing Home Staffing Levels – Something to Watch

According to new federal data, gathered by Medicare from daily payroll records from more than 14,000 nursing homes in the United States, nursing homes have been under-reporting to the government their nurse and caretaker staffing levels for years.  For families with loved ones dependent on nursing home care, this is likely not a surprise.  There are nearly 1.4 million people cared for in skilled nursing facilities in the United States.  The families of those 1.4 million people are very aware of the consequences suffered by their loved ones due to the inconsistent and insufficient staffing levels in the nursing homes.

A recent New York Times article discusses the problems with nursing home staffing levels in depth. “It’s Almost Like a Ghost Town. Most Nursing Homes Overstated Staffing for Years,” by Jordan Rau, Kaiser Health News, and reported in the New York Times, July 7, 2018.  Medicare is now relying on new data to evaluate staffing levels, and to use in the government’s nursing home rating system. The rating system previously relied on unverified reports provided by the nursing homes.  While the new system using payroll records appears to be giving a more accurate picture of staffing levels and deficiencies, there are still issues with inconsistencies in staffing levels that are not readily apparent in the data provided. Families and residents of nursing home patients report significantly fewer staff at nursing homes on weekends and holidays.  The payroll records for nursing homes show that there were, on average, 11 percent fewer nurses providing care on weekends and 8 percent fewer aides.

Even the payroll records provided to Medicare for facilities that were rated positively for staffing levels on Medicare’s Nursing Home Compare website indicate nursing homes were short on staff, including nurses, on some days of the week.  While numbers might match Medicare’s minimum expectation on most days of the week, (one registered nurse for eight hours a day and one licensed nurse at all times) those numbers drop significantly on some days.  Frighteningly, recent records show that on at least one day during the last three months of 2017, a quarter of facilities reported no registered nurses at work.  The needs of the residents don’t fluctuate based on the day of the week. They need to eat, dress, bath, and do other essential activities of life every day of the week, and medical attention is always needed.

The solution to the staffing issues at nursing homes may not be easy.  Nursing home administrators remark on the difficulty of recruiting and retaining qualified staff, when they must compete with higher paying employers.   This is especially true in higher cost of living areas such as the San Francisco Bay Area, where the tech industry has driven up costs for housing and goods.  Data shows that a nurse assistant made an average of $13.13 an hour in 2017.  This is in stark contrast to the $15.00 an hour a fast-food worker can make in the Bay Area.  While the average rate for a nurse assistant in the Bay Area is likely higher than the national average of $13.13, it is unlikely to be high enough to make recruitment and retention any better than other areas of the country.

It is very important for anyone who is looking to place a member of their family in a nursing home to look at the ratings provided by the government and private organizations for the facility, but be aware those ratings may not provide a complete picture.  We recommend you visit any facility you are considering. Find out if the facility will let you drop in any time or if they only allow pre-arranged visits, and request to talk to families and residents already at the facility.  Being informed and staying informed is the best way to make sure your family member receives the best care possible.

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