The Centers for Medicare and Medicaid Services (CMS) has lowered its star ratings for 1 in 11 of the nation’s nursing homes — almost 1,400 of them — due to either inadequate numbers of registered nurses or a failure to provide federally-mandated data that proved they had the required nursing coverage, federal records released in July show.

CMS rates nursing homes on a five-star system, considering the care provided to residents and the facilities’ compliance with federal regulations. A facility’s failure to either properly maintain adequate registered nurses staffing levels or to provide staffing data caused CMS to issue its lowest rating (1-star) to 1,387 of the nation’s 15,616 skilled nursing facilities.

Registered nurses are a vital and required component of nursing home staff.  They are highly-trained caregivers and can supervise other nurses and nursing aides.  They play a crucial role in keeping residents happy and safe. Staffing issues are also among the biggest concern for families, lawmakers, and senior citizen advocates. According to Medicare guidelines, registered nurses must be on-hand in every facility for at least eight hours a day, but one survey shows that 46% of nurses admit to having missed a change in a resident’s condition due to an increased workload. When nursing homes are not adequately staffed, and records are not well-maintained, it is difficult to determine whether residents are safe or whether the facility is following regulations at all.

Many facilities have struggled to comply with the staffing requirement. Payroll records obtained by CMS revealed lower overall staffing levels than the facilities had reported. The facilities who received a downgraded star rating either lacked a registered nurse for “a high number of days” over three months, provided data the government couldn’t verify or didn’t supply their payroll data at all. The downgraded homes reported seven or more days without any registered nurses. For about half of the facilities, the reduced staffing star ratings also lowered their overall star ratings, which are the measures displayed most prominently on the CMS website. Only 79 nursing homes in the United States have a 5-star rating.

For years, CMS didn’t verify the self-reported staffing and payroll information sent by nursing homes. After the implementation of the Affordable Care Act of 2010, CMS began collecting, reviewing and reporting this information and this year started incorporating this information into their star rating system. The report also highlights the struggle for facilities to recruit and retain key personnel. The average nursing home had only one licensed nurse caring for 17-33 residents, depending on the day. On the best-staffed days, each Certified Nursing Assistant or nurse aide cared for nine residents, but on the worst-staffed days, each aide was responsible for 16 or more residents. Staffing shortages were worse on weekends and holidays where there were 11% fewer registered nurses and 8% fewer nurse aides on hand.

CMS is hoping that additional reporting and consequences for failing to adhere to federal guidelines will add more transparency and enforcement to the industry – with the goal of improving patient safety, care, and outcomes. In a statement, CMS said  “We’ve just begun to leverage this new information to strengthen transparency and enforcement with the goals of improved patient safety and health outcomes.”

When nursing homes lack the adequate staff, or the personnel they have is overworked, there is a higher chance for abuse or neglect.  In some cases, it may be unintentional. In all cases, it is unacceptable, and our loved ones suffer.

If you or someone you love lives in a nursing home, staffing concerns may be a very relevant issue to you.  You may have had a negative experience due to a staffing shortage or lack of a registered nurse on duty, or you may be afraid of what could happen if a staffing deficiency occurs in your facility. To learn more about nursing home safety, abuse or neglect, or your legal rights, contact Trentalange & Kelley today.

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