Almost three-fourths of nursing homes in the United States “almost never” have the minimum number of nurses on staff, according to McKnight’s Long-Term Care News. The new study, which utilized a year of payroll data, found that 75 percent of facilities self-reported a number of nurses that are “almost never in compliance with” the federally required minimums. The study was produced by researchers at Harvard University and Vanderbilt University who then published their findings in Health Affairs.
The study comes on the heels of new federal guidelines on reporting nursing staff. Previously, nursing homes would provide a sample of their time-sheets to local regulators when their facility was inspected. Unfortunately, nursing homes commonly knew when inspections would occur and would respond by increasing the number of nurses on staff in the weeks before an inspection. Further, local regulators – who are typically from the state’s health department – did not always scrutinize or authenticate the time-sheets provided by the nursing home. For these reasons, the federal government created a computer system that requires nursing homes to upload payroll information on staffing levels. This new system benefits from live-updates and 24/7 monitoring of the nursing home.
In addition, the new system has also shined a light on how severely lacking the previous method was at gauging nursing levels. Under the new payroll-based computer system, McKnight’s Long-Term Care News found that 70 percent of nursing homes self-reported lower levels of nursing home staff. This means that almost 75 percent of nursing homes in the country are almost never in compliance with federal regulations on the minimum number of nurses on staff. The report found that for-profit nursing homes and corporate chains are the least likely to comply with the federal laws, followed by non-profit nursing homes and then government-run nursing homes.
Insufficient staffing at nursing homes is a serious problem. According to the researchers who authored the study, “Adverse events such as falls and medication errors might be more likely to occur during those understaffed days.” Further, the number of nurses at a nursing home is often a proxy for other measures of a nursing home’s quality. Nursing homes with fewer nurses taking care of their patients are more likely to have higher rates of pressure ulcers (bedsores). Because CMS “rarely audits” the self-reported number of pressure ulcers, the federal agency should be concerned that nursing homes may also under report these important statistics. Lacking the resources and political willpower to overhaul these regulations, David Grabowski, a co-author of the report, told McKnights, “CMS needs to address the gap between their expectations and regulations regarding RN staffing.” We could not agree more.
