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States Not Enforcing Nursing Home Staff Requirements

Published on Nov 27, 2014 at 2:36 pm in Nursing Home Abuse.

The Center for Public Integrity has discovered that thousands of nursing homes inflated their staff levels to the Nursing Home Compare website run by the Centers for Medicare and Medicaid Services (CMS). [link to prior blog?] That analysis has also shown that hundreds of nursing homes across the country have staff levels that are below state requirements.

To find actual staffing figures, the Center for Public Integrity did its own auditing. The Center looked at annual financial reports submitted by the homes — those documents contain revenue and expenditure data, along with resident population, which allow a precise calculation of staff to resident ratios.

The Center found that more than 80% of nursing homes self-reported higher RN levels on the public website than they disclosed in financial reports to Medicare. More than 25% of homes posted an overall staff level that was at least twice the level they disclosed in financial reports to Medicare.

Not only are these gaps cause for concern to families who attempt to use the public website to compare home quality, they point out that homes are in violation of state law.

A majority of states have instituted mandatory daily direct care staffing ratios. In 2010, those requirements ranged from .44 hours per resident in Arizona to 3.9 hours per resident in Florida. However, in 2012, over 700 homes — more than 250 facilities in Illinois — had daily care levels below their state requirements.

Charlene Harrington, professor emeritus of nursing at the University of California, San Francisco, told the Center for Public Integrity that the below-standard care levels illustrates a related oversight failure on both the state and federal levels.

“It’s just another symptom of not doing the oversight that they’re supposed to be doing at the state level,” Harrington was reported as saying. “CMS should demand that the states should look at it because the very first tenet of being certified is that facilities meet state law. If they haven’t met state law, CMS shouldn’t be certifying them.”

Dozens of studies have shown that the amount of care that nursing home residents receive, especially from RNs, is strongly connected with quality of care. Lower levels of care are associated with a stronger chance that patients will suffer injuries, and life-threatening incidents.

The Center says that that CMS declined to comment, because, it said, it had not seen the Center’s analysis.