Nursing Home Care levels are much lower than most of us think

I think of myself as an optimist, but when it comes to what I’ve seen in the past 11 years, I am not surprised by this recent study by the Center for Public Integrity.   The Center found that many U.S. nursing home patients may not be receiving the level of care their loved ones believe they’re getting.
Staffing levels reported by thousands of nursing homes on a widely-used government website were higher than the staff levels calculated by the Center for Public Integrity through an analysis of annual financial reports submitted by the homes, suggesting that consumers in those facilities may not be getting as many hours of skilled care as they expect. Experts have shown that the amount of care provided by nursing homes is linked to the quality of care. The inaccurate information raises significant questions about the truthfulness and veracity of the information in the Nursing Home Compare website that many consumers use to pick a nursing home for family members. The reporting discrepancies occurred for all types of positions, but were particularly high for registered nurses, the most skilled and highest paid workers.   More than 80 percent of the facilities reported higher registered nurse staffing levels on the public website than those the Center calculated through its analysis of the cost reports. In more than 25 percent of nursing homes nationwide, the amount of staff listed on the public website was at least double the level in the cost reports.
Close to 100 peer-reviewed, academic studies have shown that the amount of care, particularly that provided by registered nurses, is most strongly connected with residents’ quality of care. Lower levels of care are associated with a higher likelihood of injury and even death.  Eight of the 10 states with the largest levels of discrepancies in the reporting of RN staffing levels were southern.  Among them: Louisiana and Arkansas, where the average self-reported levels were at least twice the amount calculated through the cost reports analysis.   You might wonder where  some of our local facilities  fell?   First Coast Health & Rehabilitation Center in Jacksonville was one of the nursing homes that researchers compared.  They found the following:
Total care:  3.50 hours of care per patient per day reported on Nursing Home Compare.  3:04 hours of care per patient per day calculated from cost report.
Registered nursing care:  42 minutes of care per patient per day reported on Nursing Home Compare.  25 minutes of care per patient per day calculated from cost report.
Another local facility that researchers looked at was Regents Park of Jacksonville.
Total care: 4.01 hours of care per patient per day reported on Nursing Home Compare.  2:58 hours of care per patient per day calculated from cost report.
Registered nursing care:  34 minutes of care per patient per day reported on Nursing Home Compare.   20 minutes of care per patient per day calculated from cost report.
There are many more Jacksonville nursing homes that are listed in this report.  They include the following: West Jacksonville Health & Rehabilitation Center; Southpoint Terrace; Cypress Village; Palm Garden of Jacksonville; Lanier Manor; Southlake Nursing & Rehabilitation Center; Harts Harbor Health Care; Park Ridge Nursing Center; Consulate Healthcare of Jacksonville; North Church Nursing & Rehabilitation; Summer Brook Health Care; Atrium Health Care; Taylor Care and St. Catherine Labore Manor.
Click here to track the nursing home you are interested in and see the discrepancies in Nursing Home levels:

Systematic problem

Data on the publicly available Nursing Home Compare website, which is promoted by the government for comparison shopping, reflects staffing levels self-reported by nursing homes during a two-week period before annual inspections. Advocates say many homes work hard to prepare for these visits. As a result, critics say, those staffing levels may be artificially inflated.  In 2005, CMS, the federal agency responsible for overseeing nursing homes, said cost reports to the Medicaid program, which are harder for the public to locate and understand, are a more accurate source of information than Nursing Home Compare. The Center analyzed staffing levels in Medicare cost reports that contain largely the same information as the Medicaid documents, and compared them to those reported by Nursing Home Compare.     CMS declined to comment on this issue since it had not seen the Center’s analysis.  Some experts point to the discrepancies and answer the question that nursing homes have had a hard time keeping up with daily direct care nursing hours which have increased for residents at all levels of nursing staff from 2008 to 2013.
There is a provision of the Affordable Care Act that required a transition for nursing homes to provide  more accurate data by March 2012—a transition that still has not occurred.  In particular, the Affordable Care Act mandated that CMS implement by March 2012 an electronic data collection system by which facilities would submit payroll-based, verifiable staffing information about registered nurses, licensed practical nurses and certified nursing assistants. That information about the amount of staffing by position and staff turnover was to be published on the Nursing Home Compare website.  But on Dec. 9, 2011, Thomas Hamilton, director of the agency’s survey and certification group, wrote a memo saying that CMS would not make that deadline due to fiscal constraints.   Little progress has been made since. A pilot program to capture payroll data tested less than 1 percent of homes, according to the agency. In October, CMS said it would complete the implementation of the payroll system by the end of 2016 after receiving $11 million in funding from bipartisan legislation.

 A lack of oversight

Patient advocates know that staffing data is more important than ever because nursing home inspections are falling. A Center analysis found that the number of standard state nursing home inspections fell 6 percent from 2008 to 2012— even though the number of nursing homes fell just 1 percent during those years.  Other data indicates that hundreds of nursing homes have had staffing levels that are lower than those mandated by state laws.  Thirty-three states and Washington, DC had daily direct care staffing requirements that in 2010 ranged from .44 hours per resident in Arizona to 3.9 hours per resident in Florida, according to a survey conducted by Charlene Harrington, emeritus professor of nursing at the University of California, San Francisco.
But in 2012, more than 700 facilities, including more than 250 nursing homes in Illinois, had daily care levels that were lower than the levels required by those state laws, according to the Center’s cost report analysis.
Read more of the original study here:

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