Advocacy group calls for 'immediate' Congressional hearings into nursing home staffing

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Bob Blancato
Bob Blancato

Two days after a front-page New York Times article blasted alleged understaffing at U.S. nursing homes, the Elder Justice Coalition on Monday called for Congress to investigate.

The bipartisan group issued a statement calling “for immediate Congressional hearings into a disturbing report issued this weekend pointing to chronic staff shortages in nursing homes.”

The coalition specifically asks that hearings focus on the response by Centers for Medicare & Medicaid Services to the report since “staffing shortages went unnoticed.” The group also wants changes to CMS's star-rating system, which employs a bell curve to rate facilities' performances, “to prevent this problem in the future.”

Providers agreed with the coalition on one point Monday but also noted extremely tough staff recruiting conditions.

“We've long pushed for more accurate reporting on nursing home staffing and we agree on the need to eliminate the bell curve from the 5-Star rating system,” said LeadingAge CEO Katie Smith Sloan in an email to McKnight's on Monday. “Our members face a huge challenge in recruiting, training and retaining workers. At LeadingAge Town Hall meetings, where we gather with members from around the country, we hear again and again about worker shortages. There is no question that the aging services field is facing a workforce crisis.”

The New York Times story used the first round of Payroll-Based Journal data to make its case that nursing homes' self-reported staffing data — which the government accepted until last year — was often bogus. The investigative piece was produced in collaboration with Kaiser Health News, which supplied the writer and an analysis of PBJ records. KHN is an editorially independent program of the Kaiser Family Foundation.

It was not immediately clear what a Congressional investigation of past practices would do or mean with the PBJ system now in place. Its purpose is to act as a foil to any attempts to “game” the system (as the Times/Kaiser characterized providers' self-reported figures).

Nonetheless, providers can expect continued backlash for a while from the widely read NYT article, if history is any indicator. A representative of the nation's largest nursing home association argued Monday that staffing is just one of numerous critical ways to gauge effectiveness.

“As a profession, we are working to address workforce needs by recruiting the right people to the field and offering competitive pay and professional development. While staffing is one of many important metrics in quality care, outcomes and satisfaction are what really matters," said David Gifford, M.D., AHCA's Senior Vice President, Quality & Regulatory Affairs. "Long-term trends show dramatic improvements in outcomes across the board in key areas including, safely reducing hospitalizations, antipsychotic usage and discharges back to the community.”

The Elder Justice Coalition intends to keep the heat on.

“Although there may not be consensus on optimal staffing levels in nursing homes, this new data from CMS again reveals that many facilities do not have adequate staffing to protect the health and safety of their residents," said Bob Blancato, the coalition's national coordinator. "Staff shortages can contribute to elder abuse — most especially neglect — and we must do everything possible to prevent this,” 

Most elder abuse occurs in seniors' homes and at the hands of their relatives or acquaintances, not in institutional settings, third-party researchers have found.