An analysis of Medicare data shows that nearly half of Georgia nursing homes recently were found “below average’’ or “much below average’’ in their staffing levels of registered nurses. This is similar to the analysis for South Carolina nursing homes.
RNs are the highest-trained caregivers required to be on staff in a nursing home, and the only qualified staff to assess the residents. They are also needed to supervise LPNs and CNAs. Medicare mandates that every facility have a registered nurse working at least eight hours every day at the bare minimum. This applies to facilities with 44 beds or 220 beds!
Medicare rates RN staffing based on the average number of hours worked by registered nurses and nurse administrators for each resident. The ratings range from “much below average” to “much above average.” Of Georgia’s 346 nursing homes that were rated, 163, or 47 percent, received “much below average” or “below average” ratings of RN staffing based on Medicare data from January through March of this year, as reported by Kaiser Health News.
Medicare recently began collecting and publishing payroll data on the staffing of nursing homes as required by the Affordable Care Act. Payroll records revealed lower overall staffing levels than facilities had self-reported, especially among RNs.
Melanie McNeil, Georgia’s long-term-care ombudsman, told GHN on Monday that she wasn’t surprised by the staffing findings.
“Not enough staff is a common concern that ombudsman representatives hear from residents, family and sometimes even staff,’’ she said.
“RN staffing is important because direct-care workers may notice changes in a resident but they don’t have the training that RNs do to recognize what the change means and what action to take,’’ McNeil said.
“For years, advocates have been urging specific staffing ratios for direct care workers and nurses, including an RN 24 hours a day,’’ she added. “As a state, we should provide more incentives for individuals to enter these professions, including better wages and tuition forgiveness.”
When nursing homes are short-staffed, nurses and aides scramble to deliver meals, transport bedbound residents to bathrooms and answer calls for pain medication, KHN reported. Essential tasks such as repositioning a patient to prevent bedsores can be overlooked when workers are overburdened, sometimes leading to avoidable hospitalizations.
“We’ve just begun to leverage this new information to strengthen transparency and enforcement with the goals of improved patient safety and health outcomes,” the CMS said in a statement to KHN.
Kathy Floyd of the Georgia Council on Aging said overall staffing levels are low. “Advocates and providers are talking about possible solutions to Georgia’s lower staffing levels. I hope our next governor will look at provider reimbursement rates and please, please tie increases to quality measures.”
The new payroll data, analyzed by Kaiser Health News, showed that for-profit nursing homes averaged 16 percent fewer staff than did nonprofits, even after accounting for differences in the needs of residents. The biggest difference was in the number of registered nurses: At the average nonprofit, there was one RN for every 28 residents, but at the average for-profit, there was only one RN for every 43 residents.
The data also revealed that nursing homes have large fluctuations in staffing. The average nursing home had one licensed nurse caring for as few as 17 residents or as many as 33, depending on the day. On the best-staffed days, each certified nursing assistant or other aide cared for nine residents, but on the worst-staffed days, each aide was responsible for 16 residents, KHN reported.
On June 4, 2015, a report by the Georgia Department of Public Health revealed that Zeni was one of 35 residents and staff infected with scabies in the Shepherd Hills Nursing Home owned and operated by the national for-profit chain SavaSeniorCare.