Residents and staff gather for a dance at Ararat Nursing Home in Los Angeles in April 2021. The pandemic has exposed the dangers of understaffing nursing homes.
Mario Tama/Getty Images
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Mario Tama/Getty Images
Residents and staff gather for a dance at Ararat Nursing Home in Los Angeles in April 2021. The pandemic has exposed the dangers of understaffing nursing homes.
Mario Tama/Getty Images
update: Biden administration announced a recommendation The article, which was published on September 1, also sparked a debate about staffing ratios in nursing homes. The proposed rule would require each resident to receive 33 minutes of care a day from a registered nurse. It also requires at least one RN to be on duty at the facility 24 hours a day. For nursing assistants, the recommended care time is 2.45 hours per resident per day, and this total time is below the time investigated in the study referenced in this article. The proposed rule is open for comments until November 6.
Last year, the Biden administration promised to set a minimum staffing level for about 15,000 nursing homes across the country. It was at the center of an agenda to overhaul an industry that the government claimed was rife with substandard care and violations of federal quality regulations.
However, according to a copy of the study reviewed this week, a research study commissioned by the Centers for Medicare and Medicaid Services to identify appropriate staffing levels offered no specific recommendations, suggesting that previous major Only staffing levels lower than the best staffing levels considered by the federal assessment were analyzed, they said. From KFF Health News. Instead, new research No single staffing level guarantees quality care, the report said, but higher staffing levels lead to fewer hospitalizations and emergency department visits, faster care, and improved care. We estimate that there will be fewer failed offers.
Patient advocacy groups say the report is the latest sign the administration is failing to deliver on its promise to establish strong staffing levels to protect 1.2 million Americans in skilled nursing homes. said.
residents at risk
The administration is already six months behind schedule February voluntary deadline Suggest new rules. Proposals that have not yet been announced include: Evaluating from May to this week by the Office of Management and Budget. The study, dated June 2023, has also not been officially published, but a copy has been posted on the CMS website. The article was removed shortly after KFF Health News published it.
“It’s honestly heartbreaking,” said Richard Morott, executive director of the Long-Term Care Community Coalition, a nonprofit that helps nursing home patients in New York. “I don’t understand how this doesn’t end up putting more residents at risk of neglect and abuse. “The damage caused by the shortage of nursing home staff. “
For months, the nursing home industry has been vigorously lobbying against flat patient-to-nurse and assistant ratios. “Across the country, it’s clear that every nursing home is unique, and a one-size-fits-all approach won’t work,” said Holly B., senior vice president of quality, regulatory and clinical services at American Health Care. Harmon says. Care Association, an industry group.
hard work, low wages
Nursing home groups have stressed widespread difficulties in finding workers willing to fill existing certified nursing assistant jobs, which are often demanding and often lack workers in retail stores. lower than the wages you get. At home, licensed nurses say they are often attracted to other jobs, such as higher-paying hospital jobs. “The workforce challenge is real,” said Katie Smith Sloan, president and CEO of The Leading Age, an association representing nonprofit nursing homes.
The industry also argues that if the government wants to hire more workers, it will need to pay more through state Medicaid programs, which are the top payers of nursing home care. Advocates and some researchers say that nursing homes, especially for-profit ones, could afford to pay their workers more and hire additional staff if they gave up some of the profits they gave to investors. claim.
“Certainly, the facility hasn’t put all its money directly into healthcare in years,” said David Grabowski, a professor of health policy at Harvard Medical School. “But for some facilities, increasing staffing levels will be a huge burden,” he said in an interview last week.
Highly anticipated research
In a written statement to KFF Health News, Jonathan BlumThe chief deputy director and chief operating officer of CMS said the study was published in error.
“CMS is committed to holding nursing homes accountable for the health and safety of all residents, and proper staffing is essential to this effort,” he said. “CMS proposals are developed using a rigorous process that utilizes a wide range of sources of information, including extensive input from residents and their families, workers, managers, experts and other stakeholders. Our focus is to drive implementable solutions that promote a safe and secure environment.” Providing quality care to our residents. “
Bloom’s statement called the study a “draft,” but nothing in the 478-page study indicated it was preliminary.
This study was widely anticipated. The reasons for this are that the administration said it would play a central role in its policies, and that the last large-scale CMS study conducted in 2001 found that staffing would increase to the level of about 100 elderly people. They concluded that home care would improve. 1 worker for every 6 inhabitants. A formal measure of its staffing levels was 4.1 staff hours per resident per day. This is calculated by dividing the total hours worked by nurses and assistants each day by the number of residents enrolled each day.
CMS never adopted its staffing ratios, instead determining reasonable staffing levels at the discretion of each nursing home. Regulators rarely cite nursing home understaffing as a reason, even though independent researchers have concluded that understaffing is the cause of many injuries in nursing homes. For example, if there are too few nursing aides, immobile residents are often unable to reposition themselves in bed, resulting in pressure ulcers that can lead to infections. Understaffing also often causes residents to be exposed to humiliation, such as being left on dirty bed sheets for hours.
“sabotage”
This new study was conducted by Abt Associates, an authorized CMS contractor who also conducted the 2001 study. However, the report tacitly contradicts its predecessor, stating that “there is no apparent plateau above which quality and safety are maximized, and a ‘cliff’ below which quality and safety decline precipitously.” concluded. Abt contacted CMS with questions about his research.
Four minimum staffing levels were evaluated in this study, all of which were below the 4.1 staff hours per day identified in previous studies as being ideal. The highest he had staff hours per day was 3.88 hours. At this level, studies estimate that 0.6% of her residents are delayed in care and 0.002% do not receive the care they need. It also said the improved staffing would reduce Medicare residents’ hospitalizations by 12,100 and emergency department visits by 14,800. According to the report, three-quarters of nursing homes will need to add staff to meet that standard, which will cost them an additional $5.3 billion each year.
The lowest staffing level analyzed by the report was 3.3 hours of staffing time per day. At that level, 3.3% of residents will be delayed in care and 0.04% will not receive the care they need, according to the report. Reaching this level would result in 5,800 fewer hospitalizations and 4,500 fewer emergency room visits for Medicare residents. More than half of nursing homes will need to hire more staff to meet the ratio, according to the report, adding $1.5 billion in costs each year.
Charlene Harrington, professor emeritus of nursing at the University of California, San Francisco, said CMS “obstructed” its efforts to promote adequate staffing through instructions given to contractors. “All the thresholds we investigated were below her 4.1,” she said. “How can that be considered good research? It’s just unacceptable.”
