Sep 20, 2018

Staffing is the primary indicator of quality care

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North Carolina Health News had an article on the importance of staffing in nursing homes.  “Having enough people to handle the unrelenting work and communication at skilled nursing centers remains vital to proper care for the older people and those with disabilities housed there.”

The effect of staffing on the health of nursing home residents has been long established. A 2004 study in the journal Health Services Research found that having enough staff, especially registered nurses, resulted in “lower death rates, higher rates of discharges to home, improved functional outcomes, fewer pressure ulcers, fewer urinary tract infections, lower urinary catheter use, and less antibiotic use.”  The same study found low levels of staffing correlate with residents’ getting inadequate help with eating, developing unhealthy skin conditions, being less active, and having less frequent assistance using the bathroom.

This is just common sense.

“You can’t really deliver quality care if you don’t have enough people working,” said Thomas Konrad, who researches health-care staffing at the UNC Sheps Center for Health Services Research.  “The first thing that you see is people having to wait for someone to answer a call bell,” he said.  “You see it in inadequate responses clinically. That’s why staffing has been a primary indication of quality.”

That’s the reason why the federal Centers for Medicare and Medicaid Services spent several years crafting a more reliable approach to monitoring staffing at nursing homes. Instead of relying on the residential centers to self-report staffing numbers which led to them inflating the numbers, CMS checked through years of paycheck records, revealing, in the cases of hundreds of nursing homes nationally, much lower levels of staffing than those seen under the former method.

Also, for several years, CMS has published what staffing is expected based on the facility’s Resource Utilization Group (RUG) scores for all the residents in the facility according to CMS data.  The payroll records prove that the vast majority of nursing homes provide dramatically less than what CMS expects and less than the needs of the residents.


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