Most U.S. nursing homes experience staffing fluctuations and have been overreporting their nursing and caretaking staff levels for years, according to data analyzed by Kaiser Health News for the New York Times.
The new federal data comes from daily payroll records that Medicare began gathering and publishing from more than 14,000 nursing homes, as part of requirements of the Affordable Care Act of 2010.
Previously, Medicare rated the staffing levels of a nursing home based on the facilities unverified reports, which left the Centers for Medicare & Medicaid Services’ (CMS) Five-Star Quality Rating System open to gaming. In fact, one study found evidence that at least 6% of 1,200 California nursing homes inflated their self-reported measures for quality and staffing. But there’s no reason to believe that self-inflation was confined to that one state.
“There is nothing particular in California that would lead nursing homes to do this behavior only in California,” University of Connecticut professor Niam Yaraghi told Skilled Nursing News at the time.
The federal data, illustrated by an interactive map by the NYT, suggest strongly that the Five-Star system exaggerated staffing levels across the country over the past 10 years, according to the Times.
“Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day,” the article said.
Skilled nursing facilities across the U.S. care for almost 1.4 million people, and Medicare requires the presence of a registered nurse (RN) for eight hours a day and the presence of a licensed nurse at all times, the Times noted. But even facilities rated positively for staffing were short nurses and aides on some days, according to the payroll records. At the Beechtree Center for Rehabilitation & Nursing in Ithaca, N.Y., for instance, there was one aide for every eight residents on the best-staffed days; on the worst, there was one aide for every 18 residents.
There are legitimate reasons staff could vary, David Gifford, a senior vice president at the American Health Care Association, told the Times. Weekends, for instance, have fewer activities for residents, while more family members are around, he said.
CMS said in a statement to the Times that it is taking steps to address the staffing fluctuations that have emerged from the payroll data. The agency also said this month that it would lower ratings for nursing homes that have gone seven or more days without an RN.
CMS discouraged comparing the new data to the old method, which involved nursing homes reporting staffing for the two weeks before the inspection. The methods measure different time periods and have different criteria for recording the hours nurses worked, the agency said. However several researchers told the Times the contrast has merit because Medicare is using the data to rate nursing homes on its website, the same purpose for which the old data were gathered.
Seven in 10 nursing homes had lower staffing with the method, out of the more than 14,000 nursing homes submitting payroll records. The average decrease was 12%.
Medicare also did not rate more than 1,000 facilities, either because they were too new to have a staffing history, or because of data anomalies, the Times said.
Written by Maggie Flynn