Under the ACA, CMS started to not just take the word of nursing homes regarding how well they are staffed, and instead started looking at payrolls to find the answer. That answer was pretty shocking, Kaiser Health News (KHN) reports. So shocking, in fact, that the government slapped its lowest rating on 1,387 of the nation’s 15,616 nursing homes. Those facilities all got one star out of five last Wednesday when CMS released its findings.
One of the major issues has to do with the presence of registered nurses at the facilities. One should be on staff at least eight hours a day. All of the one out of 11 nursing homes that have been downgraded either did not have enough registered nurses on staff or failed to provide adequate documentation that they did have enough on staff.
CMS said in a statement that “we’ve just begun to leverage this new information to strengthen transparency and enforcement with the goals of improved patient safety and health outcomes.”
The agency also noted that it had given nursing homes ample warning that they needed to make sure that they were properly staffed; they’d been preparing the facilities since 2015 about the coming measuring change, and gave them a warning in April.
David Grabowski, a professor of health care policy at Harvard Medical School, told KHN that “it’s a real positive that they actually are taking the payroll-based system seriously, that they’re using it to punish those nursing homes that either aren’t reporting staffing or those that are below the federal limit.”
Katie Smith Sloan, president of LeadingAge, an association of not-for-profit providers of aging services including nearly 2,000 nursing homes, said in a statement that “our members are battling on multiple fronts to recruit and retain all types of qualified staff, and nurses in particular.”
A KHN analysis of the payroll data “showed that for-profit nursing homes averaged 16 percent fewer staff than did nonprofits, even after accounting for differences in the needs of residents. The biggest difference was in the number of registered nurses: At the average nonprofit, there was one RN for every 28 residents, but at the average for-profit, there was only one RN for every 43 residents. Researchers have repeatedly found lower staffing in for-profit facilities, which make up 70 percent of the industry.”