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

More News in this PBJ Topic

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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OIG Reports on CMS Use of Data on Nursing Home Staffing: Progress and Opportunities to Do More

However, CMS has opportunities to better use the staffing information that nursing homes report. Specifically, the staffing information that CMS provides on Care Compare could be more useful to consumers if it included data on nurse staff turnover and tenure, as required by Federal law. CMS reported that the COVID-19 pandemic delayed its progress to implement these requirements.”

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Research on How Skilled Nursing Facility Staffing Impacted by New Payment Rules

Skilled nursing facility (SNF) staffing levels across several provider types have fallen since Medicare implemented new payment rules meant to drive value over volume of services, according to a new Health Affairs study.

The study published last week found that physical therapist and occupational therapist staffing levels at SNFs fell by 5 percent to 6 percent from October to December 2019 compared to the period before Medicare implemented the Patient Driven Payment Model (PDPM).

Physical therapy assistant and occupational therapist assistant levels also decreased following PDPM implementation, falling by 10 percent compared to the pre-implementation period.

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New research examines if nursing home staff turnover a good quality metric

here are a few sub-questions we need to break down to answer before answering this one larger question. These sub-questions include:

Is nursing staff turnover at nursing homes a big problem?

Is nursing staff turnover correlated with quality of care?

Does using nursing staff turnover as a quality metric provide the right incentives?

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OIG Study: HHS Watchdog Probes Enforcement Of Nursing Home Staffing Standards

The inspector general at the Department of Health and Human Services this month launched an examination into federal oversight of skilled nursing facilities amid signs some homes aren’t meeting Medicare’s minimum staffing requirements.

The review comes on the heels of a Kaiser Health News and New York Times investigation that found nearly 1,400 nursing homes report having fewer registered nurses on duty than the Centers for Medicare & Medicaid Services (CMS) requires

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Staffing takes a front seat when driving quality of care

In CMS’s new rating methodology, facilities are rewarded for staffing more RNs — and punished when they don’t have enough. Ratings on the staffing domain are based on two measures: the number of RN hours per resident per day and total nursing hours (combined RN, LPN, and nurse aide hours) per resident per day, all pulled from quarterly Payroll-Based Journal reports

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Research Claims that Under Competitive Pressure, Nursing Homes Appear to Game Rating System

In a new article with Amanda Sharkey at the University of Chicago, Ody-Brasier took advantage of a tightening of regulations to study how closely star ratings actually track a patient outcome known to be highly correlated with quality of care. In April of 2012, the Centers for Medicare and Medicaid Services increased the level of staffing required to maintain each star rating. If 0.5 nursing hours per resident per day originally corresponded to five stars, then the new regulation might require, say, 0.6 hours to maintain this rank. Nursing homes that were on the threshold of acceptability thus needed to boost their staffing hours to maintain their star rating.

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A New Focus on Nursing Facility Staffing

The Medicare Requirements of Participation state that a facility must provide sufficient nursing staff on a 24-hour basis and a registered nurse for at least eight consecutive hours per day, seven days a week.

With this new topic, OIG will be examining nursing staffing levels that are reported by facilities electronically to CMS’ Payroll-Based Journal (PBJ). In addition, the review will address the efforts by CMS to ensure data accuracy and improve quality of care by examining the enforcement of minimum requirements and encouraging the hire of high-quality staff above required levels.

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CMS Strengthens Nursing Home Oversight and Safety to Ensure Adequate Staffing

Centers for Medicare & Medicaid Services (CMS) announced actions that will bolster nursing home oversight and improve transparency in order to ensure that facilities are staffed adequately to provide high-quality care.

These actions include sharing data with states when potential issues arise regarding staffing levels and the availability of onsite registered nurses; clarifying how facilities should report hours and deduct time for staff meal breaks; and providing facilities with new tools to help ensure their resident census is accurate.

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House Hearing Focuses on Nursing Home Safety and Quality

This week, the House Committee on Energy and Commerce (E&C) Subcommittee on Oversight and Investigations held a hearing entitled “Examining Efforts to Ensure Quality of Care and Resident Safety in Nursing Homes.” The purpose of the hearing was to explore the roles of the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General at the U.S. Department of Health and Human Services (HHS) relating to the management and safety of nursing facilities.

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