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How’s this for a risk management red flag? A recent federal study alleges that nearly every nursing home in the country is understaffed to the point that it cannot provide basic care to patients.
The study was mandated by Congress and presented by the Department of Health and Human Services (HHS). It found that 97% of nursing homes in the country did not provide minimal staffing, which it defined as allowing an average of 2.8 hours a day of care from nurse aides and 1.3 hours a day from licensed staff members. The findings are "strong and compelling evidence" in support of minimum staffing levels at nursing homes, according to the report.
Those minimum-staffing levels may not materialize anytime soon, however. The HHS report suggests that making such levels a federal requirement may cost too much. Instead, the HHS recommended a market-based solution.
In other findings, the report says that 91% of nursing homes do not have enough staff to provide routine care in these areas: dressing/grooming, independence enhancement, exercise, feeding assistance, changing wet clothes and repositioning residents, and providing toileting assistance and repositioning residents.
The solution would not be easy, the HHS says. Implementing minimum thresholds of care would require increasing wages by as much as 7% because the demand for nurses would increase, the study says. Increased staffing levels were not the only suggested solution, however. The report also suggests that non-nursing staff could be put to work during peak hours, such as mealtimes, and better policies on absenteeism might lead to having more nurses on the job on any given day.
As an alternative to mandating staffing levels, the HHS report suggests that the government might make public the staffing levels of nursing homes in hopes that public demand would spur the facilities to improve care.
The nursing home industry acknowledges the staffing problem, though it doesn’t necessarily agree with the government’s recomendations. Charles H. Roadman II, MD, president and CEO of the American Health Care Association, a leader in the nursing home industry, says the HHS study "corroborates the sentiment expressed by America’s long-term care community that the nation’s Medicare and Medicaid programs for patient care are woefully under-financed, and the staffing crisis is largely a symptom of the larger problem of chronic underfunding."
The federal concludes that the shortage of nursing personnel is "likely to become worse," and Roadman agrees.
"Yet it should come as no surprise to policy-makers that in order to increase wages and to make front line nursing jobs more competitive, Medicaid can no longer pay just slightly more than $4 per hour, per patient, for shelter, meals, labor costs, special care, certain therapies, and other items," he says. "Costs far outweigh governmental reimbursements for care, chronic underfunding of Medicaid directly impacts staffing, and this fact can no longer be denied."