Exaggerated reports regarding staffing levels in nursing homes have concealed staff shortages that put residents at risk for abuse and neglect. Federal data shows that most U.S. nursing homes falsely reported their staffing levels to government agencies over the last decade. The number of staff and caregivers on duty at most facilities was greatly exaggerated.
Federally-Funded Nursing Homes
According to recent Medicare payroll records, data shows exaggerated staffing levels and significant fluctuations in day-to-day staffing in more than 14,000 nursing homes across the country. Reports show significant under-staffing of facility staff and resident caregivers on weekends. At an average size nursing home facility on the lowest staffing days, on-duty staffs were required to attend to twice as many residents as they attended to on normal staffing days.
Federally-funded nursing homes and long-term care facilities are filled with residents who are on Medicare. Since they receive Medicare funding from the federal government, they are required by the Affordable Care Act to publish certain data on care facilities. Reports show that Medicare has been previously rating facility staffing levels based on unverified numbers provided by facility administrators. A five-star rating given for adequate daily staffing was given to many grossly understaffed nursing home facilities or facilities with erratic staffing levels during a five-day work week and on weekends.
Although Medicare does not set a minimum resident-to-staff ratio, it does require the presence of an on-duty licensed nurse at all times and an on-duty registered nurse for a minimum of eight hours a day. Medicare payroll records reveal that many facilities that received positive ratings for staffing levels had no licensed or registered nurses on duty on some days.
In the United States, there are approximately 1.4 million people living in skilled nursing home facilities. The Centers for Medicare & Medicaid Services, the federal agency that oversees nursing home inspections, reports that it is concerned about recent Medicare payroll reports that show exaggerated staffing levels. It is taking steps to address staffing problems and make sure that residents are adequately cared for in federally-funded nursing home facilities.
New Rating Systems
In April, the federal government replaced the old method for staffing ratings with a new system. They began using daily payroll reports to calculate average staffing ratings, instead of relying on reports provided by facility administrators that were furnished prior to facility inspections. They found that some nursing homes anticipated when an inspection would occur and increased staff levels prior to the inspection. In 2017, records show that 25 percent of facilities reported no registered nurses on duty for one day or several days during a work week. As a result, the government said that it will lower ratings for nursing homes that go seven or more days without a registered nurse on duty.
Although the new payroll reporting system may help with staffing levels, Medicare’s five-star rating system still has flaws. Medicare still assigns stars for ratings by comparing one nursing home to other facilities, essentially grading on a curve. As a result, many nursing homes have kept positive ratings despite inadequate staffing levels. Medicare refuses to set specific minimum resident-to-staff ratios and states that it prefers each federally-funded nursing home to establish staffing levels based on the needs of its residents.
Under-Staffing Puts Residents at Risk
Under-staffing has been a serious problem for nursing homes for decades. Approximately 90 percent of nursing homes are understaffed. Residents who live in understaffed nursing homes have a higher risk for serious illnesses and infections, as well as elder abuse and neglect. When nursing home facilities are understaffed, mistakes and neglect happen more frequently and residents suffer elder abuse by frustrated, overworked, and stressed-out caregivers.
When there is a shortage of nurses on staff, nursing home residents are put at increased risk for health problems, accidents, and injuries. Residents face a greater risk of falls, malnutrition, dehydration, bedsores, missed medications, and other forms of neglect. On-duty staff members and caregivers are forced to care for more residents who require help with basic tasks such as eating and drinking, bathing and hygiene, dressing, and standing, as well as residents who require daily meals and medications at specific times. It’s inevitable that many resident needs will be overlooked when nursing homes are short-staffed and workers are overburdened.
Nursing homes are understaffed for a variety of reasons, but one main reason is cost. The labor costs for nursing homes are very high compared to other facility costs. Facilities often can’t afford to pay for as many licensed and registered nurses as they need, so they stretch their budget by under-staffing. Some nursing homes struggle to retain qualified medical professionals. Nursing home facilities offer a difficult, high-stress work environment with a high turnover rate. Many nurses prefer to work for private physicians or hospitals where duties are often less stressful and paychecks are higher.