It's Almost Like a Ghost Town. Most Nursing Homes Overstated Staffing for Years

[Not_A_Hat_Person, RN]

Thanks to Obamacare-related data collection, the federal government has realized something many nurses have known for years- many nursing homes are deliberately understaffed. Perhaps this will lead to change.

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ITHACA, N.Y. - Most nursing homes had fewer nurses and caretaking staff than they had reported to the government for years, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate.

The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends. On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest.

The data, analyzed by Kaiser Health News, come from daily payroll records Medicare only recently began gathering and publishing from more than 14,000 nursing homes, as required by the Affordable Care Act of 2010. Medicare previously had been rating each facility's staffing levels based on the homes' own unverified reports, making it possible to game the system.

The payroll records provide the strongest evidence that over the last decade, the government's five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common. Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.

[brownbook]

Thanks, I can't believe nursing homes are still getting away with this c**p. Or maybe I didn't understand how they were getting away with it.

[kjb_lpn]

Speaking as a former nursing home employee - everything is true. Nursing homes are terribly understaffed. One of many reasons we should push for safe, adequate staffing.

[Tenebrae, BSN, RN]

Given the current status quo and the for profit nature of nursing homes, adequate staffing is unlikely.

[Bostonnurse06]

I have worked in nursing homes for 10 years, and I'm now in upper management. I can tell you from experience that nursing homes would love to staff more, but just don't have the money. Between cuts in Medicare and Medicaid, and ACOs pushing for arbitrary outcomes, many nursing homes are barely staying afloat. It's very hard to attract and retain quality staff because those that are good at their jobs leave to go to hospitals. Of course there are some nursing home companies, especially the national chains, that are just in it for the profit. But most of the nursing home administrators I have met are doing their best with an ever-decreasing budget

[CapeCodMermaid, RN]

If we could find good staff we'd hire them in a second. Competition is fierce and reimbursements don't cover the daily cost of caring for a resident- especially one on Medicaid.

[mambo5]

This info is true.

I had 47 residents at night with my coworker.

[SheriffLauren]

I worked at a gero psych unit at a hospital. Our unit suffered from lack of funding. We liked the patients and the job but a lot of people leave because they get tired of not having the proper tools and having broken equipment.

[Not_A_Hat_Person, RN]

Medicare Slashes Star Ratings for Staffing at 1 in 11 Nursing Homes

Medicare has lowered its star ratings for staffing levels in one out of 11 of the nation's nursing homes - almost 1,400 of them - because they were either inadequately staffed with registered nurses or failed to provide payroll data that proved they had the required nursing coverage, federal records released this week show.

Medicare only recently began collecting and publishing payroll data on the staffing of nursing homes as required by the Affordable Care Act of 2010, rather than relying as it had before on the nursing homes' own unverified reports.

The payroll records revealed lower overall staffing levels than the homes had disclosed, particularly among registered nurses. Those are the highest-trained caregivers required to be in a nursing home, and they supervise other nurses and aides. Medicare mandates that every facility have a registered nurse working at least eight hours every day.

"It's a real positive that they actually are taking the payroll-based system seriously, that they're using it to punish those nursing homes that either aren't reporting staffing or those that are below the federal limit," said David Grabowski, a professor of health care policy at Harvard Medical School. "Could they do more? Sure, but I think it's a really good start."

[Neats, BSN]

As a LNHA and BSN I can see how you all would view this but let me shed some light on this subject. Most nursing homes profit range from 1-2 percent annually. For business this is clearly not the best scenario and a catastrophic occurrence could have that slim profit from happening...i.e. new roof, new dishwasher. I am speaking about nursing home chains not the locally owned ones. Some profit comes form the selling of land that the facility bought years ago and no longer needs or just does not have the monies to develop that land. Some profit comes from accepting Sub acute rehab for a specific amount of time on Medicare and the patient goes home after rehab. This has been a saving grace for many facilities. Most residents in SNF are on Medicaid. The reimbursement for Medicaid is this:

Medicaid reimbursement is based on urban and rural factors and I think many are based on 1995 statistics and are jointly funded by the state and federal government. Paying for nursing home care costs with Medicaid means you qualify for low socioeconomic earnings, the average monthly cost for a Medicaid person is $2000.00 per month NO MATTER WHAT THEIR ACUITY LEVEL IS. There are a lot of conditions that must be met and this can differ from state to state. Typically we see what is considered spending down assets that can include car(s), or a home, and this depends on if married or not. In order to get the SNF cares you must be an individual who is unable to afford to pay for the medical care you need based on what you own, and what you have for assets.

Most Medicare services covered are in a Managed Care delivery system this means no matter what the services needed Medicaid will pay out the same amount. If the patient receives higher level of services the providers receive less per service, again because Medicaid pays out the same amount. Think about this mix of say 50 percent Medicaid, 30 percent Medicare and maybe 20 percent commercial to include private. For Medicare these people stay up to an average of 90 days then go home. Commercial/private pay has restrictions and most private pay are spending down until they get Medicaid. Commercial has a set number of days before the insurance says well this is all you have, you must get the cares in your own home or private pay. This leaves 50 percent already on Medicaid and these people are depending on your care for everything. SNF are truly not a money maker.

There are fraud facilities and this is what we hear all the time and fortunately this is not the norm. Most of the time we strive to give the best care we can with the limited amount of staff because this is all we can afford. The expectations of a SNF have come a long way from the days of when we tied residents to a hand rail in a posey vest. The incidents of workers comp remain high due to the hard job of taking care of these residents. There is no easy fix except with staffing rations which cost monies which the state and federal government control. It is not all big business stuffing their pockets, the reality is this SNF model is not working for our seniors, the reimbursement is not that big, and the rules/regulations often cause more work than we can afford.

I do know that SNF's get a bad reputation when trying to provide services that clearly are needed (otherwise we would not have so many), that reimbursement needs to change to reflect the cares that are needed for the regulations we must adhere to. Currently we do not have that. What we have now is rules from CMS that make us jump through hoops to serve and make the resident happy, unfortunately making people happy cost monies we do not have.

[CapeCodMermaid, RN]

We lose an average of $37/day on a Medicaid resident. Today our Medicaid census was 115 out of 171. 115x37=4255. Multiply that times 31 days=131,905 we're losing a month. It's a scary business.

[Daisy4RN]

And to all the above examples of losing money add the patients who come to the facility Medicaid pending, or who no longer qualify based on need but have no where else to go and because you cannot just kick them out they are there with zero reimbursement.