Following recent national furor over nursing home staffing levels, the federal government declared Friday it is stepping up oversight measures, including more focused surveys. Industry advocates say the announced changes won’t help.
The Centers for Medicare & Medicaid Services announced that it will be turning up the heat, particularly on weekends. The changes come after a Kaiser Health News analysis in July uncovered an average of 11% percent fewer direct-care nurses and 8% fewer aides on duty on weekends.
Analysts also showed that one-fourth of nursing homes reported no registered nurse on duty for at least one day during a three month period — despite the Medicare requirement that an RN be on duty at least eight hours per day.
As part of their new initiative, regulators this month will start telling states when staffing shortages appear. They’ll also clarify how skilled nursing facilities should report hours and deduct meal breaks. In addition, administrators will be offered CMS tools to ensure that census counts are accurate.
The State Operations Manual has required states to conduct at least 10% of standard health surveys on the weekend or during off-hours. For facilities on the new lists being provided by CMS, however, states will have to conduct at least half of the required off-hours surveys on weekends.
“Today CMS is taking important steps to protect nursing home residents,” Administrator Seema Verma said in a statement, noting that recently employed payroll-based journal reporting was the impetus for these changes. “We’re deeply concerned about potential inadequacies in staffing, such as low weekend staffing levels or times when registered nurses are not onsite, and the impact that this can have on patient care.”
Industry trade groups said Friday that they appreciate CMS’s intent, but don’t believe its actions will address the field’s ongoing staffing challenges.
“Unfortunately, today’s action by CMS will enforce policies that make it even more difficult to meet regulatory requirements and hire staff,” David Gifford, senior VP of quality and regulatory affairs at the American Health Care Association told McKnight’s. “Rather than taking proactive steps to address the national workforce shortage, long-term care facilities are facing, CMS seems to be focusing on a punitive approach that will penalize providers and make it harder to hire staff to meet the shared goal of increasing staffing.”
LeadingAge CEO Katie Smith Sloan said that while PBJ data has helped to improve the accuracy of reporting, it is still relatively new and the group’s members continue to experiencing administrative difficulties with the reporting changes. She said that staffing is a complicated issue — driven by inadequate Medicaid reimbursement and fierce competition from other sectors — that nursing homes are working hard to address.
“We believe any discussion of nursing home staffing must be considered in the broader context of the labor force,” she told McKnight’s on Friday. “Our nonprofit members across the care continuum — including nursing homes — face a significant workforce crisis. Nursing homes go to extreme measures to staff sufficiently.”
