Staffing Crisis in Long-Term Care

Across the country, nursing homes are limiting admissions due to staffing shortages.  Hospitals and families are being impacted as seniors face restricted access to appropriate care.  Long-term care leaders are asking lawmakers for resources to help expand staffing options; however, looming federal mandates on staffing minimums are predicted to make the situation worse.

Staffing Statistics / Patients Searching for Beds:

According to the Bureau of Labor Statistics, nursing homes have lost 241,000 (15.2% of its workforce) since the start of the pandemic.  In a recent survey conducted by the American Health Care Association (AHCA), 61% of nursing homes are limiting new admissions, and 73% are concerned they will have to close facilities due to staffing shortages.  Over half of the nursing homes surveyed indicated they cannot sustain these increased costs and operating losses for more than one year.

AHCA/NCAL reports that despite having available beds, nursing homes across the country do not have enough workers to care for their residents.  For example, in Massachusetts, over 1,000 patients are waiting to be discharged from hospitals but are being denied admission to nursing homes due to short staffing.

Federal Mandates / Industry Proposals:

In February 2022, the White House issued a Fact Sheet entitled Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes.  This statement included implementation of minimum staffing standards by CMS.  CMS is studying minimum staffing requirements and plans to have a proposal on the mandates in 2023.  In the meantime, Payroll-Based Journal staffing data will be used for inspections beginning in October 2022.  Surveyors will use the PBJ data to identify non-compliance with staffing, which includes registered nurse and licensed nursing hours.

Nursing shortages are affecting all areas of healthcare, but impacting long-term care the hardest.   According to the president and CEO of AHCA, these “unfunded staffing mandates would only make the crisis worse.  Congress must invest in our long-term care workforce and protect access to care for millions of seniors.”

As of July 2022, CMS is including staff turnover rates on the Medicare Care Compare website.  These measures include:

  • Total nurse staffing hours per resident, per day on weekends.
  • Total nursing staff turnover within a given year.
  • Annual registered nurse turnover.
  • Annual number of administrators who left the nursing home.

The National Academies of Science, Engineering, and Medicine released “The National Imperative to Improve Nursing Home Quality – Honoring the Commitment to Residents, Families, and Staff” in April 2022.  This 605-page report provided seven goals to ensuring high-quality care, emphasizing that each recommendation is interdependent.  One of the goals is to ensure a well-prepared, empowered, and appropriately compensated workforce, which the report notes is contingent on sufficient reimbursement.

Impact on Care / Defending Staffing-Related Allegations:

According to CNA insurance, insufficient staffing is often cited by plaintiff attorneys in both negligence and wrongful death lawsuits.  Liability claims that identify a lack of monitoring due to low staffing levels include, but are not limited to:

  • Falls.
  • Pressure injuries.
  • Infections.
  • Preventable harm.
  • Inadequate staff interaction with residents.
  • Delayed response to declines in physical condition.
  • Failure to instruct the resident to call for assistance.
  • Untimely notification of family/physician on adverse incidents/changes in condition.

As staffing levels are clearly tied to quality of care, it is critical to the defense to have the means to quickly assess workforce status.  The Payroll-Based Journal staffing data that nursing homes submit to the CMS website each quarter is public, searchable, and permanent.  Excelas’ Staffing Scorecard makes this data easily accessible and useful to facility administrators, their insurers, and legal representatives.  These reports:

  • Identify fluctuations or inconsistencies that occurred in staffing levels during a certain period.
  • Quickly compare a facility’s staffing levels with others in a specified geographic footprint.
  • Dig deeper into a facility’s particular staffing issues.
  • Level the playing field by knowing the information plaintiffs are using to evaluate cases and potentially create a negative staffing narrative.

Contact Excelas today for a demonstration of how the Staffing Scorecard can be an effective tool in defending long-term care cases.

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