In what Kaiser Health News calls “a crackdown” on short-staffed nursing homes, the Centers for Medicare and Medicaid Services (CMS) has just downgraded the ratings of one-tenth of the nation’s nursing homes. That’s according to this article recently published on the Kaiser Health News website. The biggest problem area: a chronic lack of nursing staff.
Shortfall in Nursing: More than 1,600 Homes Downgraded
“The federal government accelerated its crackdown on nursing homes that go days without a registered nurse,” Kaiser reports, “by downgrading the rankings of a tenth of the nation’s homes on Medicare’s consumer website, new records show.” According to the article, when CMS updated its popular Nursing Home Compare website in April, the agency “gave its lowest star rating for staffing — one star on its five-star scale — to 1,638 homes. Most were downgraded because their payroll records reported no registered-nurse hours at all for four days or more, while the remainder failed to submit their payroll records or sent data that couldn’t be verified through an audit.”
As anyone who has searched for a high-quality nursing home can attest, the process can be confusing and time-consuming. That’s why CMS began rating these facilities in 2008 using a scale of one to five stars. The nation’s 15,000 nursing homes are rated in three areas: health inspections, staffing, and quality of resident care. But a big change took place last summer when the federal government, in response to concerns about a shortage of qualified nurses and other critical staff, stopped relying on the facilities self-reporting their staffing levels and started requiring nursing homes to submit actual payroll records. The results were alarming. “The records for the first time reveal frequent and significant fluctuations in day-to-day staffing,” Kaiser reported at the time, “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.”
We reported on this data-gathering change here on the AgingOptions blog in July 2018. We also reported in this AgingOptions blog post last December that CMS was about to boost the number of unannounced weekend inspections in response to staffing concerns. Clearly the issue is receiving a lot of high-level attention.
Shortfall in Nursing Means a Potential Drop in Quality of Care
The most recent Kaiser Health News article suggests that the staffing crisis isn’t getting any better at the nation’s nursing homes. “CMS has been alarmed at the frequency of understaffing of registered nurses,” Kaiser reports, especially on weekends when nurse staffing is considered “particularly anemic.” The reason for the crackdown is simple, in the view of CMS: it’s all about patient health. As CMS reported a few months ago, “Nurse staffing has the greatest impact on the quality of care nursing homes deliver, which is why CMS analyzed the relationship between staffing levels and outcomes. CMS found that as staffing levels increase, quality increases.”
As the Kaiser Health News article explains, because of how the CMS ratings are calculated on Nursing Home Compare, a downgrade in the ranking for staffing doesn’t necessarily translate into a drop in the facility’s overall rating, which is the metric that most people pay attention to. When Kaiser reviewed the overall rating of the 1,638 homes that had seen their staffing score downgraded, they found that 30 percent were still rated as three, four or even five stars. But overall, many nursing homes – slightly more than one-third – saw their ratings drop, which caused a predictable outcry of protest from the nursing home industry. The American Health Care Association, a trade group for nursing homes, accused CMS of “moving the goal posts” by arbitrarily cracking down on staffing levels. Operators also claim – paradoxically, we think – that payroll records don’t necessarily paint an accurate picture of precisely when nurses are on duty.
Shortfall in Nursing: Resources to Help Families
In our July 2018 AgingOptions blog post we offered some excellent resources for families to use when selecting a nursing home for a loved one. For example, we ran across this helpful checklist from the website Caring.com. Medicare offers this 9-page Nursing Home Checklist that you can print and take with you when you visit. Then of course, there are the comprehensive ratings available at Medicare’s Nursing Home Compare website which lets you search and evaluate by zip code. But published ratings and checklists aren’t enough: the key, say the experts, is to visit in person and see for yourself. Families need to evaluate nursing facilities objectively using some of the tools we’ve listed, and talk to residents and their families to get the real picture of what it’s like to live there. This is also a time when you and your family will want to call on the services of a senior housing professional such as the staff at Better Care Management. They help families handle the complexities associated with aging, including in-home care, housing placement, hospitalization and government programs, and they can advocate for your loved one if at any time you suspect he or she is receiving substandard care. Contact our office during the week if you would like more information about their services.
Make Sure the Pieces Fit Together
Housing is a critical element in retirement planning, but it’s only one facet of many that must be taken into account in order for your plan to be truly complete. For example, you may have the best housing plan in place, only to have it derailed by an unexpected medical crisis. This in turn triggers a financial crisis which can precipitate a family crisis. Health, housing, finance and family all have to be considered together, along with the necessary legal framework to help you protect your assets as you age and avoid becoming a burden to those you love. Fortunately, that type of highly comprehensive planning is readily available today, in the form of an AgingOptions LifePlan, an approach to retirement planning that is truly groundbreaking. Please come join us and find out more, without cost or obligation, by attending a free LifePlanning Seminar with Rajiv Nagaich. We offer these highly popular, information-packed sessions in locations throughout the region: you can click here for our current listing, then register for the date and time that works for you. It will be a pleasure meeting you soon at an AgingOptions LifePlanning Seminar with Rajiv Nagaich. Age on!
(originally reported at www.khn.org)