Aging Options

Kaiser Health News: Feds Order More Weekend Nursing Home Inspections to Uncover Chronic Staffing Shortages

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Nursing homes that are operating with unacceptably low weekend staffing are about to get a surprise. An article we just read on the Kaiser Health News website reports that CMS – the Centers for Medicare and Medicaid Services – has ordered state inspectors to begin conducting more unannounced inspections on weekends, when staffing shortages are the worst.

Cracking Down on Staffing Shortages

“The federal government announced plans Friday to crack down on nursing homes with abnormally low weekend staffing by requiring more surprise inspections be done on Saturdays and Sundays,” the Kaiser article reports. CMS said it will “identify nursing homes for which payroll records indicate low weekend staffing,” and also single out those who are currently violating federal guidelines by operating without a registered nurse during the required portion of the day. CMS will then issue instructions to state inspectors to focus on those potential violations during these surprise weekend visits.

“Since nurse staffing is directly related to the quality of care that residents experience, CMS is very concerned about the risk to resident health and safety that these situations may present,” the agency said in its recently-issued directive. This new policy comes on the heels of a report from Kaiser Health News last summer revealing chronic understaffing of nursing homes on weekends: the exposé showed about ten percent fewer staff available for resident care on Saturdays and Sundays. We wrote about this report here on the AgingOptions blog. Our article described “a troubling fact 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.”  As a result, said the Kaiser report, many nursing homes exhibit “a pattern of erratic staffing and substandard care.”

5-Star Rating System “Flawed”

CMS issues a rating system that evaluates nursing homes on a scale of one to five stars, a system that many families rely on in selecting a place for a loved one to live. Some have complained that the rating system is flawed because much of the data on which it is based is self-reported. This 2016 report from the Center for Medicare Advocacy warned consumers not to be “fooled” by the rating standard and accused many facility operators of “gaming” the system to boost their ratings. To help stem this practice, CMS began requiring nursing homes to submit payroll records so staffing could be independently evaluated. “Those records, which became public this year, showed lower staffing than what facilities had previously told inspectors during their visits,” according to the Kaiser Health News analysis.

Technically the requirement for weekend inspections isn’t new. Current CMS rules require that ten percent of nursing home inspections must occur on weekdays before 8:00AM or after 6:00 PM, or on weekends – what are considered “off hours.” But for those facilities identified by CMS as having lower-than-acceptable weekend staffing, the new regs require that half of those off-hour inspections must now take place on Saturdays or Sundays.  One advocacy group welcomed the new rules but noted that the real problem lies with haphazard oversight from state inspectors who “don’t take this seriously.” Richard Mollot of the New York-based Long Term Care Community Coalition complained, “How many studies do we have to have, year after year, decade after decade, saying it all comes down to staffing, and there are very few citations for inadequate staffing and virtually all of them are identified as not causing any resident harm?” It appears, his statement suggests, that inspectors are letting poorly staffed nursing homes off the hook.

Staffing Shortages Result in Lower Evaluations

Some facilities have had their ratings downgraded by CMS over the issue of registered nurse staffing. “Medicare requires nursing homes to have a registered nurse on site for at least eight hours every day,” says Kaiser, “but according to the payroll records, a quarter of nursing homes reported no registered nurses available at least one day during a three-month period.” Beginning last summer, CMS began highlighting homes lacking sufficient RN availability on the agency’s Nursing Home Compare website. Since then more than 1,400 facilities out of a total of 15,600 have had their ratings downgraded for gaps in registered nurse staffing.

As we said here on the AgingOptions blog in last summer’s article on this topic, when it comes to choosing the right place for a loved one who needs nursing care, the keys are straightforward. Visit the home in person – especially during off hours – and see for yourself. Make an objective evaluation 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. 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

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