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Changes in reporting shed light on nursing home staffing issues

All of us who have loved ones in nursing homes are concerned about the staffing levels. We know that patients in an understaffed facility are more likely to suffer injuries because someone isn't always available to help them when they want or need to move. There are more likely to be errors in dispensing medication. Patients are more likely to get bedsores because they aren't turned or allowed to get up regularly.

It wasn't until recently, thanks to the 2010 Affordable Care Act and the requirements for Medicare and Medicaid funding, that we got an accurate picture of nursing home staffing levels. The law mandates that information about the patient-staff ratio of facilities be obtained directly from payroll records. In the past, the information had been self-reported by the facilities, and numbers could easily be inflated. That and other helpful information is available on the Nursing Home Compare section of the Medicare.gov website.

This more accurate information led Medicare to lower its staffing-related ratings on about 9 percent of the nursing homes in the country. The payroll information, which reflects hourly staff only, showed that facilities had fewer nurses and aides than they'd been telling the government they had. In some cases, staffing levels fluctuated considerably throughout the week, with weekends particularly understaffed.

While the government doesn't mandate minimum overall staffing levels for nursing homes, Medicare does require that a registered nurse (RN) be on duty a minimum of eight hours a day. Unfortunately, according to a study by Kaiser Health News, the payroll data Medicare was receiving indicated that some nursing homes didn't even meet that basic requirement for "a high number of days" or couldn't show that they were meeting the requirement.

Interestingly, Kaiser's study found that nonprofit nursing homes had better staffing than for-profit ones. There was a 16 percent difference, on average. The most significant difference was in the number of RNs.

Thanks to Nursing Home Compare and other resources, families have access to more (and more accurate) information about nursing homes than in the past. However, sadly, too many families don't become aware of understaffing or other issues until a loved one is injured or becomes ill due to nursing home neglect or abuse. When that happens, you owe it to your loved ones and to other patients and families to hold the nursing home legally accountable for its actions or negligence.

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