Study finds nursing homes rarely have enough RNs on staff

Jul 30, 2019 | Research Studies of PBJ Data, Nursing HPRD & Turnover

PBJ research report and related news:

Health affairs journal

Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations

Staffing is an important quality measure that is included on the federal Nursing Home Compare website. New payroll-based data reveal large daily staffing fluctuations, low weekend staffing, and daily staffing levels often below the expectations of the Centers for Medicare and Medicaid Services (CMS). These data provide a more accurate and complete staffing picture for CMS and consumers.

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Geng, Fangli, et al. “Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations. Health Affairs, vol. 38, no. 7, 2019, pp. 1095–100. Crossref, www.healthaffairs.org/doi/10.1377/hlthaff.2018.05322.

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Study finds nursing homes rarely have enough RNs on staff

RN staffing levels fall much lower than CMS standards in most nursing homes, according to a study published July 1 in Health Affairs.

“Seventy-five percent of nursing homes were almost never in compliance with what CMS expected their RN staffing level to be,” the study’s authors wrote. They also found half of skilled nursing facilities only met standard staffing benchmarks on 19 days or fewer between April 2017 and March 2018.

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Kommers, Anne-Marie. “Study Finds Nursing Homes Rarely Have Enough RNs on Staff.” Becker Hospital Review, 2 July 2019, www.beckershospitalreview.com/post-acute/study-finds-nursing-homes-rarely-have-enough-rns-on-staff.html.

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Nursing Home Staffing Shows Wide Fluctuations, New Research Shows

New research published in July’s issue of Health Affairs finds wide variability in nurse staffing at U.S. nursing homes.

Across all types and sizes of facilities and all nurse levels, there is variations in the staffing of nursing home facilities. Among the primary findings in the study, in which David Stevenson, PhD, a professor of health policy at VUMC, is low weekend staffing and daily staffing levels that often fall well below the expectations of the Centers for Medicare and Medicaid Services (CMS), all of which can increase the risk of adverse events for residents.

The study is among the first to use new payroll-based journal (PBJ) data that CMS began collecting in 2016 as part of requirements in the Affordable Care Act. Prior to 2016, staffing levels at nursing homes were self-reported and unaudited, making the data questionable and at risk for error or bias.

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“Nursing Home Staffing Shows Wide Fluctuations, New Research Shows | Department of Health Policy.” Vanderbilt University, 2 July 2019, www.vumc.org/health-policy/nursing-home-nurse-staffing-data-research.

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Nurse Staffing at Nursing Homes Is Lacking

Nursing homes only met nurse staffing requirements less than 60% of the time, a new analysis finds.

When patients are admitted to a nursing home, it’s usually because they’re unable to care for themselves at home. While it’s a difficult choice, families often make the decision to ensure their loved ones get the care and assistance they need.

But a new analysis of payroll-based staffing data for U.S. nursing homes, uncovered large daily staffing fluctuations, low weekend staffing, and daily staffing levels that often fall well below the expectations of the Centers for Medicare and Medicaid Services.

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HealthLeaders. “Nurse Staffing at Nursing Homes Is Lacking.” HealthLeaders Media, www.healthleadersmedia.com/nursing/nurse-staffing-nursing-homes-lacking-0

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New data resource reveals highly variable staffing at nursing homes

Researchers who analyzed payroll-based staffing data for U.S. nursing homes discovered large daily staffing fluctuations, low weekend staffing and daily staffing levels that often fall well below the expectations of the Centers for Medicare and Medicaid Services, all of which can increase the risk of adverse events for residents.

A study published in the July issue of Health Affairs paints a picture of the staffing levels of nurses and direct care staff at nursing homes based on a new CMS data resource, the Payroll-Based Journal, or PBJ. CMS has been collecting data from nursing homes since 2016 to meet a requirement of the Affordable Care Act, and PBJ data has been used in the federal Five-Star Quality Rating System for Nursing Homes since April 2018.

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Lagasse, Jeff. “New Data Resource Reveals Highly Variable Staffing at Nursing Homes.” Healthcare Finance News, 3 July 2019, www.healthcarefinancenews.com/news/new-data-resource-reveals-highly-variable-staffing-nursing-homes.

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Nursing Home Residents at Risk: Study Finds Significant Understaffing in 75% of Skilled Nursing Facilities

A recent study found significant understaffing in 75% of nursing facilities across the country, raising concerns about the level of care patients receive.

The Harvard and Vanderbilt study, published in the July issue of the Journal of Health Affairs, used data from the Payroll Based Journal (PBJ) to analyze the staffing levels of more than 15,000 facilities. The study examined the staffing levels of registered nurses (RN), licensed practical nurses (LPN), and nurse aides, relative to the number of nursing home residents who rely on their care.

Understaffing is an ongoing issue for nursing facilities.

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“Nursing Home Residents at Risk: Study Finds Significant Understaffing in 75% of Skilled Nursing Facilities.” The National Law Review, 22 July 2019, www.natlawreview.com/article/nursing-home-residents-risk-study-finds-significant-understaffing-75-skilled-nursing

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‘Staggering’ 75% of nursing homes almost never meet expected RN staffing levels, study finds

Three-fourths of the nation’s nursing homes never meet federal staffing expectations for registered nurse staffing, and RNs are often missing from such facilities on the weekends, according to a new review of a year’s worth of payroll data.

The research also found that 70% of facilities self-reported higher total direct staffing under the CASPER system than in the now-standard Payroll-Based Journal. The discrepancy was most pronounced at for-profit facilities, followed by non-profits and then government-run buildings.

Researchers from Harvard and Vanderbilt medical schools examined records from 15,399 nursing homes covering April 2017 through March 2018. Their results were published online by Health Affairs Monday afternoon.

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Marselas, Kimberly. “‘Staggering’ 75% of Nursing Homes Almost Never Meet Expected RN Staffing Levels, Study Finds.” McKnight’s Long-Term Care News, 2 July 2019, www.mcknights.com/news/staggering-75-of-nursing-homes-almost-never-meet-expected-rn-staffing-levels-study-finds.

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75% of Nursing Homes ‘Almost Never’ in Compliance with RN Staffing Levels

The gulf between self-reported and payroll-based staffing records for nursing homes continues to widen, with a new study showing a reality that vastly differs from government expectations.

The amount of registered nurse (RN) coverage falls well below the standards set by the Centers for Medicare & Medicaid Services for most skilled nursing facilities in the country, a team from Harvard and Vanderbilt University reported in a study published Monday in the July issue of the journal Health Affairs.

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Spanko, Alex. “75% of Nursing Homes ‘Almost Never’ in Compliance with RN Staffing Levels.” Skilled Nursing News, 1 July 2019, skillednursingnews.com/2019/07/75-of-nursing-homes-almost-never-in-compliance-with-rn-staffing-levels.

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RN staffing is inadequate: study

An analysis of a year’s worth of payroll data has revealed that as many as 75% of U.S. nursing homes do not meet federal expectations for registered nurse staffing.

Investigators from Harvard and Vanderbilt also said that 7 out of every 10 facilities self-reported higher total direct staffing levels than could be verified in the now-standard Payroll-Based Journal.

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Berklan, James. “RN Staffing Is Inadequate: Study.” McKnight’s Long-Term Care News, 1 Aug. 2019, www.mcknights.com/print-news/rn-staffing-is-inadequate-study

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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.

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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.

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State of Skilled Nursing Facilities Today, Planning for the Future

What are the four key findings and what can nursing home leaders do today to put themselves on the path of recovery? Some of the answers include strategic planning, operational assessments, and self-evaluation.

Nursing facilities should work now to determine changes that can be made – clinically, operationally, and financially – for better or more strategic outcomes.

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