From The Elder Abuse Reform Now's "The Silver Standard News"
The Systematic understaffing of America's nursing homes.
Most Nursing Homes Have Overstated Staffing for Years
A recent analysis by the New York Times and Kaiser Health News
confirms what many families of nursing home residents have long
suspected—staffing is often inadequate to provide proper care for their
loved ones. Records show the number of nursing aides fluctuates
significantly from day to day, with particularly large deficits
occurring on weekends. In fact, on the lowest-staffed days, personnel
take care of twice as many residents as they do on the highest-staffed
The analysis is based on a newly implemented system of documenting
staff numbers in nursing homes, which has been designed to provide
greater accuracy. Thus, records for the first time reveal the extent and
magnitude of personnel deficiencies in facilities across America.
Approximately 70 percent of 14,000 nursing homes have lower staff
numbers than the previous system reported. The average staffing decrease
is 12 percent. Records also show that on weekends, 11 percent fewer
nurses and 8 percent fewer aides are on duty.
Federal law doesn’t mandate a minimum staff-to-patient ratio. The
only requirement is that a registered nurse be on site eight hours a day
and that a licensed nurse be on site at all times in certified nursing
homes. Data from the last quarter of 2017 disclose that one fourth of
the facilities had no registered nurse at work.
Previous Nursing Home Rating System Misled Consumers
Since 2009, Medicare had used a nursing home rating system that
assigned from one to five stars to each facility based largely on three
criteria. Two of the criteria were derived from unverified self-reported
data. Because no procedure was in place to validate the data, it could
paint an inaccurate picture of staffing levels.
While the remaining criterion came from annual health inspections
conducted by independent reviewers, this assessment could be
manipulated. It was possible for nursing homes to anticipate the
inspection and temporarily schedule more staff during that time, thus
enabling them to inflate their staffing numbers. After the inspection
was finished, the staffing would return to its inadequate level.
Consequently, the ratings failed to reflect reality, and consumers were
New Nursing Home Rating System Has Greater Accuracy
Now, due to the Affordable Care Act of 2010, which has only recently
been implemented, data on nursing home staffing is more accurate.
Instead of coming from self-reports, it’s based on daily payroll
records. The discrepancies between earlier staffing records and the new
records provide evidence that staffing levels reported over the last ten
years have been exaggerated. The data shows that even facilities with
good Medicare ratings for staffing have shortages in nurses and aides on
Despite the more reliable method of determining staff numbers, the
new rating system still has some drawbacks. Medicare assigns stars to
facilities by comparing one nursing home to another, which is, in
effect, grading on a curve. Therefore, many facilities have kept their
ratings, even though payroll records show they have lower staffing
levels than previously reported. Although the ratings can be found on
Medicare’s Nursing Home Compare website, they aren’t dependable
indicators that a facility has enough staff to provide quality care.
Patient Advocacy Group Calls for Congressional Hearings
After the recent report in the New York Times, an advocacy
group known as the Elder Justice Coalition (EJC) called for immediate
congressional hearings on chronic nursing home staff shortages. Group
members are specifically concerned that the shortages have gone
unnoticed up until now.
“We’re asking Congress to take a good hard look at staff shortages,”
said the coalition’s national coordinator, Bob Blancato, in an interview
with the Silver Standard News. “The new system may not be
living up to expectations. Perhaps after clarification there could be
legislation that would come forward.
“Several things need to be considered: number, quality, and training
of staff. If part of the problem in attracting and keeping staff is due
to wages that aren’t competitive with other types of medical facilities,
this needs to be addressed. There has to be an incentive for people to
want to go to work. The lack of workforce required to care for the aging
population is a crisis that will be in front of us for years.”
Consequences of Understaffing
Understaffing is one of the causes that underlie elder abuse and
neglect in nursing homes: reports NursingHomeAbuseGuide.org. Research
shows that when staff are overworked and stressed, patients have a
higher risk of bedsores, dehydration, malnutrition, weight loss,
pneumonia, and infections. The exhaustion that accompanies working in
short-staffed conditions can result in mistakes and failures to notice
adverse changes in patients’ health. Moreover, frustration that comes
from overwork can lead to intentional or unintentional mistreatment.
Tips for Choosing a Nursing Home
Because the current rating system doesn’t guarantee a nursing home is
adequately staffed, families of the elderly should investigate
candidate facilities thoroughly when the need for placement of a loved
one becomes apparent. Assistive Living Today provides the following tips
in choosing a home:
⋅ Instead of scheduling a visit, make a surprise visit to get an
idea of cleanliness and quality of care. If the facility looks
promising, make at least two additional trips to observe meals and
⋅ Check the public record for violations of state code. Note the
type of complaints to see if they are related to serious issues.
⋅ Conduct research to see what licenses are required in your state, and ask the facility to show you its credentials.
⋅ Observe the residents to see if they appear happy, well-groomed, and actively engaged.
⋅ Pick a facility that doesn’t have a strong odor. Don’t be fooled
by a strong deodorizer scent that may be masking the smell of urine and
⋅ Ask the facility if it has dieticians and if they can accommodate special dietary needs.
⋅ Since activities are important, inquire whether an activities
director is on staff, and find out whether outdoor activities are
⋅ If your loved one has a condition requiring special care, such
as Alzheimer’s disease or diabetes, ask if the staff has experience in
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