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Staffing levels seldom cited by state surveyors

March 18, 2014
by Sandra Hoban, Managing Editor
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To improve quality of care, the federal Nursing Home Reform law requires skilled nursing facilities (SNFs) to employ a sufficient number of staff members (F-tag 353) to meet their residents' needs. Although, as the Centers for Medicare & Medicaid (CMS) noted in a 2001 report, most nursing homes fall short of this requirement, a recent analysis by the Center for Medicare Advocacy (CMA) found that insufficient staffing is seldom cited by state surveyors. Of those nursing homes that receive a deficiency for staffing, financial penalties seldom are imposed.

State surveyiors measure nursing home quality using protocols developed and tested by CMS. Deficiencies are classified by the scope (number of residents affected) and the severity of the noncompliance. CMA reviewed data on staffing deficiencies cited from 2010 to 2013. Although most staffing deficiencies were at a "no harm" level, even those facilities cited for "immediate jeopardy" often were not sanctioned.

In 2013, only three jeopardy-level staffing citations were issued nationwide. According to the CMA report: “Failure to enforce standards of care, including staffing requirements, harms residents. In the first analysis of adverse events in nursing facilities, the [U.S. Department of Health and Human Services] Office of Inspector General (OIG) reported this week that 32 percent of Medicare beneficiaries who went to SNFs and spent an average of 15.5 days in the SNF in August 2011 experienced an adverse event or other harm, including hospitalizations and death. The physician reviewers concluded that 59 percent of the adverse events and incidents of harm were preventable and that ‘many events were the result of failure by SNF staff to monitor residents or staff delay in providing necessary medical care’–staffing problems. CMS must better enforce federal Requirements of Participation to protect nursing home residents.”