In a recent Office of Inspector General report, we learned that federal overseers are not happy about nursing home staffing levels.
In brief, nearly 1,000 operators (7%) were found to have had more than 30 days without the required amounts of nurse staffing in 2018. Also, 900 had 16 to 29 days that weren’t up to snuff. Prepandemic, these stats set up a convenient “See, we told you so” gambit.
It already has happened with regard to infection control citations. Regulators have pointed out you never washed your hands enough as an industry for years before the pandemic. Such slovenly habits certainly don’t help when trying to contend with the public health story of the century, they reason. Hard to argue there.
While the Centers for Medicare & Medicaid Services requires a minimum number of nursing hours per day, the OIG actually took issue with the fact that regulators do not use Payroll-Based Journal data to enforce the staffing requirements. PBJ data help form staffing star ratings for the consumer-facing Nursing Home Compare website.
“This raises concerns that some nursing homes may not have fully met their residents’ needs in 2018,” wrote OIG report authors, who also electronically surveyed 20 local long-term care ombudsmen.
This is important because you’ll remember that two years ago, CMS started a policy that knocks a provider’s staffing rating down to 1 star automatically if it has seven or more days in a quarter with no reported RN time. While the OIG indicated overall progress with regard to staffing levels, it identified a problem: Investigators said staffing star ratings on Nursing Home Compare didn’t match what providers were reporting day-to-day. Not all facilities had widely varying staffing levels on a day-to-day basis, but some did.
That’s why OIG recommends (wait, here it comes …) that CMS “enhance” its oversight of providers’ daily staffing levels. This is to work in coordination with exploring “ways to provide consumers with additional information on nursing homes’ daily staffing levels and variability.” The push, you see, is to find a way to reflect day-to-day staffing fluctuations and not just quarterly averages. This will naturally make some providers flinch while better ones shrug.
CMS did not “explicitly” agree or disagree with the OIG’s recommendations, but the agency said it was working on achieving them all the same. The bottom line? Don’t expect flowers and air kisses when CMS comes forward again on this issue.
From the September 2020 Issue of McKnight's Long-Term Care News
