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Gaps in Nursing Home Staffing Underreported

Quality of care is called into question after evaluation of new numbers

Care worker and senior man with medicine bottles.
Understaffed nursing homes could affect quality of care.
Getty Images

Nursing homes have been overstating their staffing levels when reporting numbers to the government, according to new federal data analyzed by Kaiser Health News and reported by the New York Times.

Analysis of payroll records of more than 14,000 nursing homes revealed many staff fluctuations – particularly on the weekends. "On the worst staffed days at an average facility, the new data show on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest," the Times reported.

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The payroll records were gathered and published by Medicare as a requirement of the Affordable Care Act of 2010. Prior to the ACA requirement, facility ratings were based on nursing homes reporting their own staffing levels.

The Times article includes a searchable map that contains the staffing rate of the 14,000 nursing homes that provided data. Staffing rates were ranked from "much above average" to "much below average."

With fewer nurses and caretaking staff available, the quality of care provided to residents is being called into question.

As reported in the Times: "Volatility means there are gaps in care," said David Stevenson, an associate professor of health policy at Vanderbilt University School of Medicine in Nashville, Tenn. "It's not like the day-to-day life of nursing home residents and their needs vary substantially on a weekend and a weekday. They need to get dressed, to bathe and to eat every single day."

At the same time, there is no minimum resident-to-staff ratio set by Medicare. The only requirement is that a registered nurse be present eight hours a day and a licensed nurse 24/7. The Centers for Medicare & Medicaid Services (CMS), which oversees the government's Five-Star Quality Rating System, uses staffing as one of the variables in determining a facility's score.

The CMS said in a statement to the Times that it "is concerned and taking steps to address fluctuations in staffing levels" that have emerged from the new data. This month it said it would lower ratings for nursing homes that had gone seven or more days without a registered nurse.