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Family Suspicions Confirmed: New Federal Data-Gathering Reveals Chronic Understaffing at Nursing Homes Nationwide

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An eye-opening article just published on the website of Kaiser Health News reveals a troubling fact which most U.S. nursing homes would rather hide: the staffing levels at more than 14,000 facilities nationwide turn out to be far lower than the levels these nursing homes had previously reported to the federal government. The result, says Kaiser, is a pattern of understaffing, erratic staffing and substandard care.

“Like a Ghost Town”

“Neglect Unchecked,” reads the title of the Kaiser Health News exposé: “Erratic Nursing Home Staffing Revealed Through New Records.” At times, especially nights and weekends, some facilities, said one resident, are “like a ghost town,” with no staff to be found who aren’t already swamped with residents and their needs.

“Most nursing homes had fewer nurses and caretaking staff than they had reported to the government, according to new federal data,” the Kaiser article reports, “bolstering the long-held suspicions of many families that staffing levels were often inadequate. The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on 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.”

New Data Source Reveals the Truth

This dramatic reporting discrepancy has only recently come to light since the Centers for Medicare and Medicaid Services (CMS) began evaluating nursing home staffing based not on self-reported data but on daily payroll records, a change required under the Affordable Care Act. CMS had been using staffing data under the old self-reporting system as part of its controversial five-star rating system, a tool used by many residents and their families in evaluating nursing facilities. The old reporting method, Kaiser asserts, allowed facilities to “game the system,” but now things have changed. “The payroll records provide the strongest evidence that, over the past decade, the government’s five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common,” says the report. “Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.”

According to statistics quoted in the Kaiser article, skilled nursing facilities in the United States currently provide care to about 1.4 million residents. “When nursing homes are short-staffed,” Kaiser reports, “nurses and aides scramble to deliver meals, ferry bedbound residents to the bathroom and answer calls for pain medication. Essential medical tasks such as repositioning a patient to avert bedsores can be overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations.”  As an example, the article singled out one facility in Ithaca, New York, which had received good marks for staffing under the previous system. When this nursing home was fully staffed, it had a ratio of one aide for every eight residents – but on its days of lowest staffing the ratio plummeted to 1-to-18. Indeed, according to CMS, 70 percent of the 14,000 U.S. nursing homes studied now show lower staffing than before, with an average decrease of 12 percent.

How Do Families Decide?

What then is a family to do when it comes to selecting a nursing home for a loved one? If you do an online search for “How to evaluate a nursing home,” you’ll find plenty of possible answers. For example, we ran across this helpful checklist from the website Medicare offers this 9-page Nursing Home Checklist that you can print and take with you when you visit. Then there’s the ratings available at Medicare’s Nursing Home Compare website which lets you search and evaluate by zip code.  We noticed a disclaimer on the site that reads, “Because we’re implementing a new Nursing Home health inspection process, we’ve changed how the star ratings are calculated.” If you’re relying on older search data, it may be time to update.

When it comes to choosing the right place for a loved one who needs nursing care, the keys, say the experts, are to visit in person and see for yourself; evaluate the facility objectively using some of the tools we’ve listed; talk to residents and their families to get the real picture of what it’s like to live there; and, when necessary, advocate for your loved one if at any time you suspect he or she is receiving substandard care. This is also a time when you and your family will want to call on the services of a senior housing professional such as the staff at Better Care Management. They help families handle the complexities associated with aging, including in-home care, housing placement, hospitalization and government programs. Contact our office during the week if you would like more information about their services.

Make Sure the Pieces Fit Together

Housing is a critical element in retirement planning, but it’s only one facet of many that must be taken into account in order for your plan to be truly complete. For example, you may have the best housing plan in place, only to have it derailed by an unexpected medical crisis. This in turn triggers a financial crisis which can precipitate a family crisis. Health, housing, finance and family all have to be considered together, along with the necessary legal framework to help you protect your assets as you age and avoid becoming a burden to those you love.  Fortunately, that type of highly comprehensive planning is readily available today, in the form of an AgingOptions LifePlan, an approach to retirement planning that is truly groundbreaking. Please come join us and find out more, without cost or obligation, by attending a free LifePlanning Seminar with Rajiv Nagaich. We offer these highly popular, information-packed sessions in locations throughout the region: you can click here for our current listing, then register for the date and time that works for you. It will be a pleasure meeting you soon at an AgingOptions LifePlanning Seminar with Rajiv Nagaich. Age on!

(originally reported at

Photo Credit: ProPublica

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