Kaiser and NYT analysis: ‘It’s Almost Like a Ghost Town.’ Most Nursing Homes Overstated Staffing for Years

Jul 30, 2018 | Research Studies of PBJ Data

News Digest: New York Times and Kaiser Health News Reports

A bombshell joint Kaiser Health News and New York Times report brought nursing home staffing into the spotlight and cast a bright light on payroll-based journal data – in the first widely publicized analysis of PBJ data.

For the first time, nursing homes realized the impact of how third parties interpret the publicly available PBJ reports they’d been submitting for the past two years.  And the public perception of the PBJ data led quickly to congressional hearings and updates to the PBJ data submission strategies.  In particular, the reporting raised questions on:

  • Lower levels of RNs than previously reported
  • Weekend nursing levels vs. weekdays
  • Downgrades on Five Star ratings for nursing homes
Kaiser health news

‘Like A Ghost Town’: Erratic Nursing Home Staffing Revealed Through New Records

Most nursing homes had fewer nurses and caretaking staff than they had reported to the government for years, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate.

The records for the first 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.

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“‘Like A Ghost Town’: Erratic Nursing Home Staffing Revealed Through New Records.” Kaiser Health News, 13 Jul. 2018, khn.org/news/like-a-ghost-town-erratic-nursing-home-staffing-revealed-through-new-records.

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It’s Almost Like a Ghost Town.’ Most Nursing Homes Overstated Staffing for Years

Medicare has lowered its star ratings for staffing levels in 1 in 11 of the nation’s nursing homes — almost 1,400 of them — because they either had inadequate numbers of registered nurses or failed to provide payroll data that proved they had the required nursing coverage, federal records released last week show.

Medicare only recently began collecting and publishing payroll data on the staffing of nursing homes as required by the Affordable Care Act of 2010, rather than relying as it had before on the nursing homes’ own unverified reports.

The payroll records revealed lower overall staffing levels than homes had disclosed, particularly among registered nurses.

READ FULL ARTICLE

Rau, Jordan. “‘It’s Almost Like a Ghost Town.’ Most Nursing Homes Overstated Staffing for Years.” The New York Times, 7 July 2018, www.nytimes.com/2018/07/07/health/nursing-homes-staffing-medicare.html.

Kaiser health news

1,400 Nursing Homes Get Lower Medicare Ratings Because Of Staffing Concerns

Medicare has lowered its star ratings for staffing levels in 1 in 11 of the nation’s nursing homes — almost 1,400 of them — because they either had inadequate numbers of registered nurses or failed to provide payroll data that proved they had the required nursing coverage, federal records released last week show.

Medicare only recently began collecting and publishing payroll data on the staffing of nursing homes as required by the Affordable Care Act of 2010, rather than relying as it had before on the nursing homes’ own unverified reports.

The payroll records revealed lower overall staffing levels than homes had disclosed, particularly among registered nurses.

READ FULL ARTICLE

Rau, Jordan, Elizabeth Lucas. “1,400 Nursing Homes Get Lower Medicare Ratings Because Of Staffing Concerns.” Kaiser Health News, 30 July 2018, khn.org/news/1400-nursing-homes-get-lower-medicare-ratings-because-of-staffing-concerns.

Kaiser health news

Look-Up: How Nursing Home Staffing Fluctuates Nationwide

This tool shows how Medicare rates overall staffing and registered nurse staffing by facility.  It also shows the average number of residents that each nurse and aide must care for on the best- and worst-staffed days.  You can sort the facilities by column or hover over them on the interactive maps to view staffing levels.

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Look-Up: How Nursing Home Staffing Fluctuates Nationwide.” Kaiser Health News, 3 May 2019, khn.org/news/look-up-how-nursing-home-staffing-fluctuates-nationwide.

Kaiser health news

Mining A New Data Set To Pinpoint Critical Staffing Issues In Skilled Nursing Facilities

The Centers for Medicare & Medicaid Services is not known for linguistic playfulness. Nonetheless, at least one person there must have been chuckling when it named its rich new data source for nursing home staffing levels the Payroll-Based Journal, or PBJ.

Like that classic sandwich, the PBJ data set is irresistible. CMS created it to fulfill a requirement of the Affordable Care Act to improve the accuracy of its five-star staffing ratings on Medicare’s Nursing Home Compare website. The data set contains payroll records that nursing homes are required to submit to the government.

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Rau, Jordan. “Mining A New Data Set To Pinpoint Critical Staffing Issues In Skilled Nursing Facilities.” Kaiser Health News, 2 Aug. 2018, khn.org/news/mining-a-new-data-set-to-pinpoint-critical-staffing-issues-in-skilled-nursing-facilities.

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Report: Poor Staffing Ratings In Houston Nursing Homes

TRYING TO FIND THE RIGHT NURSING HOME facility for an elderly family member is almost always tricky since it’s difficult to tell just from visiting a place whether you’re making the right choice for your loved one.

However, there is data out there, and Kaiser Health News recently mined that data to evaluate nursing homes across the country, including a selection of those in Houston. Their findings? More than half of nursing home facilities—roughly 60 percent—examined in Houston are understaffed.

Their analysis, issued last month, is based on an examination of the data gathered by Payroll-Based Journal (PBJ) when it conducted a study nursing homes across the country from January to March 2018 in a report for Centers for Medicare and Medicaid.

READ FULL ARTICLE

“Report: Poor Staffing Ratings In Houston Nursing Homes.” Houstonia Magazine, 14 Aug. 2018, www.houstoniamag.com/news-and-city-life/2018/08/houston-nursing-homes-poor-ratings.

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Staffing totals don’t add up

Nursing homes were placed under a hot spotlight in mid-July after The New York Times ran a lengthy story criticizing fluctuations and apparent understaffing revealed through a new federal data collection process.

The article focused on a Kaiser Health News analysis of Payroll-Based Journal data, which only recently replaced providers’ self-reported figures.

READ FULL ARTICLE

Berklan, James. “Staffing Totals Don’t Add up.” McKnight’s Long-Term Care News, 9 Aug. 2018, www.mcknights.com/news/staffing-totals-dont-add-up

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LeadingAge counters after Senator’s staffing demands

A leading industry advocate is firing back, a few days after one U.S. senator demanded changes related to nursing home staffing.

Last week, Sen. Ron Wyden (D-OR) sent a sharply worded letter to the head of the Centers for Medicare & Medicaid Services. In it, the ranking member of the U.S. Senate Committee on Finance demanded answers on how the federal government plans to better hold nursing homes accountable for staffing decisions, in the wake of a critical New York Times story.

LeadingAge countered those remarks on Friday

READ FULL ARTICLE

Stempniak, Marty. “LeadingAge Counters after Senator’s Staffing Demands.” McKnight’s Long-Term Care News, 21 Aug. 2018, www.mcknights.com/news/leadingage-counters-after-senators-staffing-demands

More News in this PBJ Topic

CMS starts study to support minimum staffing proposal

There was a stark, though not at all unexpected, dichotomy between participants in Monday’s listening session to gather input on coming nursing home staff minimums.

On the one hand, you had consumer advocates — armed with the Biden administration’s aggressive reform push and 20 years of resentment about perceived understaffing — ready to throw fuel on the fire.

And on the other, there were nursing home leaders from major organizations, mid-sized chains and tiny, independent facilities in rural settings pleading with federal regulators to douse the flames.

Where a resident advocate might see the potential for more staffing rules to help nursing homes rise from the ashes of COVID, providers are legitimately worried that a well-intentioned but under-supported mandate might just burn the sector down for good.

read more

Study of Antipsychotic Use Connection to Staffing Levels

Researchers reported a 0.75% decrease in inappropriate antipsychotic prescribing per unit increase in overall staff-to-patient ratio. There was a 3.09% decrease in inappropriate antipsychotic prescribing per unit increase in licensed staff hours.

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Research shows COVID-19 vaccination mandates don’t negatively affect nursing home staffing

State COVID-19 vaccination mandates increased vaccinations among direct caregivers without negatively affecting staffing levels, according to the results of a study published Friday in JAMA Health Forum.

The researchers studied vaccination rates and staffing shortages that were reported via the Center for Disease Control and Prevention’s National Healthcare Safety Network from June 6, 2021, through Nov. 14, 2021.

read more

Nursing home staff turnover up 25 percent from last year

The national nursing home staff turnover rate for all employees is up 25% from last year. That’s according to findings included in the 45th annual Nursing Home Salary & Benefits Report released Thursday by Hospital & Healthcare Compensation Service.

The average national turnover rate across executive-level positions and those in dining services, environmental services, marketing and therapy was 29.17%, according to the report. The national average turnover among registered nurses, licensed practical nurses and certified nursing assistants was 38.68%.

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Study confirms lower turnover linked to higher quality of care

Nursing home providers should consider implementing innovative strategies for retaining workers after a new study found that low staff turnover was consistently associated with higher quality of care, researchers said.

“While these actions are challenging — especially given that nursing homes are navigating the COVID-19 pandemic, they are clearly warranted if we seek an improved quality of care for nursing home residents,” Qing Zheng, Ph.D., lead author and health economist at research firm Abt Associates

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Study Shows Weekend and Daily Variation in Nursing Home Staffing Led to Poorer Clinical Quality

Daily variation in nursing home staffing was associated with poorer clinical quality in Medicare and Medicaid-certified nursing homes, suggesting that reporting staffing variation could help provide new quality improvement information, according to a study published in JAMA Network Open.

Typically, nursing home quality regulations include minimum staffing standards to ensure that facilities provide residents with quality care. Meeting the average staffing level has been associated with better performance on process quality measures, on-site survey scores, and resident outcome measures.

read more

Appropriate Staffing Standards in Post-Acute and Long-Term Care

A push to mandate staffing levels at both state and federal levels persists after several decades.

Skilled Nursing Facilities (SNFs) and long-term care (LTC) facilities (also referred to as nursing homes or nursing facilities) are no longer just for aging geriatric residents. Acuity level has increased and entering residents are younger, and/or with far more medically and socially complex needs (including more management of behaviors, tracheostomies, complex wound care, drains/tubes, life vests, and IV medications). In addition, experiences during the COVID-19 pandemic confirmed the importance of having sufficient staffing based on facility need and of hiring high-quality, well-trained staff.

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