Most Nursing Homes Overstated Staffing for Years

‘It’s Almost sort of a town .’ Most Nursing Homes Overstated Staffing for Years

ITHACA, N.Y. — Most nursing homes had fewer nurses and caretaking staff than they had reported to the govt for years, consistent with new federal data, bolstering the long-held suspicions of the many families that staffing levels were often inadequate.

The records for the primary time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends.

On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest.

The data, analyzed by Kaiser Health News, come from daily payroll records Medicare only recently began gathering and publishing from quite 14,000 nursing homes, as required by the Affordable Care Act of 2010.

Medicare previously had been rating each facility’s staffing levels based on the homes’ own unverified reports, making it possible to game the system.

The payroll records provide the strongest evidence that over the last decade, the government’s five-star scoring system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that was common.

Medicare is now relying on the new data to gauge staffing, but the revamped star ratings still mask the erratic levels of individuals performing from day to day.

At the Beechtree Center for Rehabilitation & Nursing here, Jay Vandemark, 47, who had a stroke last year, said he often roams the halls trying to find an aide not already swamped with work when he needs help putting on his shirt.

Especially on weekends, he said, “It’s almost sort of a town .” Nearly 1.4 million people are cared for in skilled nursing facilities within us.

When nursing homes are in need of staff, nurses and aides scramble to deliver meals, ferry bedbound residents to the toilet, and answer involves pain medication.

Essential medical tasks like repositioning a patient to avert bedsores are often overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations.

How Staffing Fluctuates at Nursing Homes Around the United States?

The number of workers at quite 14,000 nursing homes across the state varies drastically.

“Volatility means there are gaps in care,” said David Stevenson, a professor of health policy at Vanderbilt University School of drugs in Nashville, Tenn.

“It’s not like the day-to-day life of home residents and their needs vary substantially on a weekend and a weekday. They need to urge dressed, to wash, and to eat every single day.”

David Gifford, a senior vice chairman at the American Health Care Association, a nursing home trade group, disagreed, saying there are legitimate reasons staffing varies.

On weekends, for instance, there are fewer activities for residents and more family members around, he said.

“While staffing is vital, what really matters is what the general outcomes are,” he said.

While Medicare doesn't set a minimum resident-to-staff ratio, it does require the presence of an RN for eight hours each day and a licensed nurse in the least times.

The payroll records show that even facilities that Medicare rated positively for staffing levels on its home Compare website, including Beechtree were short nurses and aides on some days.

On its best staffed days, Beechtree had one aide for each eight residents, while on its lowest staffed days, there was just one aide for 18 residents.

Nursing levels also varied.

The Centers for Medicare & Medicaid Services, the agency that oversees nursing home inspections, said in a statement that it “is concerned and taking steps to address fluctuations in staffing levels” that have emerged from the new data.

This month, it said it would lower ratings for nursing homes that had gone seven or more days without a registered nurse.

Beechtree’s payroll records showed similar staffing levels to those, it had reported before.

David Camerota, chief operating officer of Upstate Services Group, the for-profit chain that owns Beechtree, said during a statement that the power has enough nurses and aides to properly care for its 120 residents.

But, he said, like other nursing homes, Beechtree is in “a constant battle” to recruit and retain employees whilst it's increased pay to be more competitive.

Mr. Camerota wrote that weekend staffing may be a special challenge as employees are guaranteed every other weekend off.

“This impacts our ability to have as many staff as we would really like to have,” he wrote.

The new rating method remains flawed?

In April, the govt started using daily payroll reports to calculate average staffing ratings, replacing the old method, which relied on homes to report staffing for the 2  weeks before an inspection.

The homes sometimes anticipated when an inspection would happen and will staff up before it.

The new records show that on a minimum of at some point during the last three months of 2017 —the most recent period that data were available — 1 / 4 of facilities reported no registered nurses at work.

The Centers for Medicare & Medicaid Services discouraged comparison of staffing under the two methods and said nobody should expect them to “exactly match.”

The agency said the methods measure different time periods and have different criteria for a way to record hours that nurses worked. The home industry also objected, with Mr.

Gifford saying it had been like comparing Fahrenheit and Celsius temperatures.

But several prominent researchers said the contrast wasn't only fair but also warranted, since Medicare is using the new data for an equivalent purpose because the old: to rate nursing homes on its website.

“It’s a worthwhile comparison,” said David Grabowski, a professor of health care policy at Harvard school of medicine.

Of the quite 14,000 nursing homes submitting payroll records, seven in 10 had lower staffing using the new method, with a 12 percent average decrease, the info show.

And as numerous studies have found, homes with lower staffing attended have more health code violations — another crucial measure of quality.

Even with more reliable data, Medicare’s five-star scoring system still has shortcomings.

Medicare still assigns stars by comparing a home to other facilities, essentially grading on a curve.

 As a result, many homes have kept their rating albeit their payroll records showed lower staffing than before.

Also, Medicare didn't rate quite 1,000 facilities, either due to data anomalies or because they were too new to have a staffing history.

There is no consensus on optimal staffing levels.

Medicare has rebuffed requests to line-specific minimums, declaring in 2016 that it preferred that facilities “make thoughtful, informed staffing plans” supported the requirements of residents.

Still, since 2014, health inspectors have cited one among every eight nursing homes for having too few nurses, federal records show.

With nurse assistants earning a mean of just $13.23 an hour in 2017, nursing homes compete for workers not just with better paying employers like hospitals, but also with retailers.

Understaffing leads predictably to higher turnover.

“They get burned out and that they quit,” said Adam Chandler, whose mother lived at

Beechtree until her death earlier this year. “It’s been constant turmoil, and it never ends.”

Medicare’s payroll records for the nursing homes showed that there have been, on average,

11 percent fewer nurses providing direct care on weekends and eight percent fewer aides.

Staffing levels fluctuated substantially during the week also, when an aide at a typical

the home may need to worry for as few as nine residents or as many as 14.

A family council forms?

Beechtree actually gets its best Medicare rating within the category of staffing, with four stars.

(Its inspection citations and therefore the frequency of declines in residents’ health dragged

its overall star rating right down to two of 5 .)

To Stan Hugo, a retired mathematics teacher whose wife, Donna, 80, lives at Beechtree, staffing levels have long seemed inadequate.

In 2017, he and a couple of other residents and family members became so dissatisfied that they formed a council to scrutinize the home’s operation.

Medicare requires home administrators to concentrate on such councils’ grievances and proposals.

Sandy Ferreira, who makes health care decisions for Effie Hamilton, a blind resident, said Ms.

Hamilton broke her arm rupture of bed and has been hospitalized for dehydration and septic shock.

“Almost every problem we’ve had on the ground is one that would are alleviated with enough and well-trained staff,” Mrs. Ferreira said.

Beechtree declined to debate individual residents but said it had investigated these complaints and didn't find inadequate staffing on those days.

Mr. Camerota also said that Medicare doesn't count assistants it hires to handle the only duties like making beds.

In recent months, Mr. Camerota said, Beechtree “has made major strides in taking note of  and addressing concerns associated with staffing at the power .”

Mr. Hugo agreed that Beechtree has increased daytime staffing during the week under the prodding of his council. On nights and weekends, he said, it still remained too low.

His wife has Alzheimer’s, uses a wheelchair, and not talks.

She enjoys music, and Mr. Hugo placed earphones on her head so she could hear her favorite singers as he spoon-fed her lunch within the dining room on a recent Sunday.

As he does every day he visits, he counted each nursing assistant he saw tending residents, took a photograph of the official staffing log within the lobby and compared it to what he had observed.

While he fed his wife, he noted two aides for the 40 residents on the floor — half what Medicare says is average at Beechtree.

“Weekends are terrible,” he said. While he’s regularly there overseeing his wife’s care, he wondered: “What about of these other residents? They don’t have people that are available.