Sep 13, 2018

Inflating Staffing Numbers

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The Charlotte Sun had an interesting article on the nursing home industry’s inflation of staffing numbers to CMS.  Researcher Niam Yaraghi is an assistant professor with the University of Connecticut School of Business, who co-authored a paper last year in the journal Production and Operations Management, titled “Winning at all costs: Analysis of inflation in nursing homes’ rating system.”

Yaraghi sees a big problem.  Much of the data the government measures to rate nursing homes throughout the country is self-reported, and according to Yaraghi, it isn’t audited by the CMS.

I think the current system is a shameful system, which is harming our senior citizens by disguising highly inflated data into a five-star rating system,” Yaraghi said. “Imagine having a tax code, and requiring people to file their taxes, without having the IRS to audit them. Most people would start underreporting their income and overreporting their expenses to avoid taxes, with no fear of being caught. We have the exact same system for nursing homes.”

Yaraghi said he and other researchers found out that 8 percent of nursing homes in California were “seriously inflating their self-reported measures.”  This is consistent around the entire country.

CMS doesn’t have a comprehensive picture of what’s going on.  CMS should create an auditing system where nursing homes are randomly audited, and then fine anyone caught cheating the system.

“We have an ongoing research project to develop such an audit strategy for CMS, and would share it with CMS administrators as soon as the paper is peer-reviewed and published,” said Yaraghi.

“Staffing and quality measures are both important aspects of services provided at nursing homes,” said Yaraghi. “However, CMS does not have the resources to independently audit and inspect all of these measures, and therefore should choose between more data with lower reliability or less data with higher reliability. CMS has chosen the first option and is collecting a lot of data but is compromising on the quality of data which I think is sad because it defeats the whole purpose of evaluating nursing homes.”

The Five Star Rating System is a source for individuals and families to learn important information about nursing homes to help support their healthcare decisions. However, CMS advises stakeholders to seek other sources of information as well, such as visiting the nursing home and speaking to the administrator, other staff, current residents, or the resident council to obtain valuable insight about the nursing home.

Lawsuits frequently cite evidence of inadequate staffing and profit motives for the inadequate care provided at the nursing homes.

AHCA sent the Sun a press release from earlier this year on nursing home staffing from a Kaiser Family Foundation report, which the agency said showed Florida is a “leader” in nursing home staffing.  “Experts recommend at least 4.55 HPRD (nurse hours per resident day) in nursing facilities,” the press release shows. “Certified nursing facilities in Florida averaged 4.55 HPRD compared to the national average of 4.05.”



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Advocacy · Staffing

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