The website Claims Journal reported on a study published in the July issue of Health Affairs where researchers analyzed payroll-based staffing data for U.S. nursing homes.  Researchers discovered large daily staffing fluctuations, low weekend staffing and daily staffing levels that often fall well below the expectations/standards of the Centers for Medicare and Medicaid Services (CMS).  The situation dramatically increases the risk of adverse events for residents.

The study paints a picture of the staffing levels of nurses and direct care staff at nursing homes based on a new CMS data resource, the Payroll-Based Journal (PBJ). CMS has been collecting data from nursing homes since 2016, and PBJ data have been used in the federal Five-Star Quality Rating System for Nursing Homes. CMS compares nursing homes’ reported staffing to expected levels based on the acuity of residents in the facility.

Using PBJ data from more than 15,000 nursing homes, the research team discovered that only 54% of facilities met the expected level of staffing less than 20% of the time during the one-year study period. For registered nurse staffing, 91% of facilities met the expected staffing level less than 60% of the time.

Relative to weekday staffing, the PBJ data showed a large drop in weekend staffing in every staffing category. On average, weekend staffing time per resident day was just 17 minutes for RNs, nine minutes for LPNs and 12 minutes for nurse aides (NAs).

Staffing in the nursing home is one of the most tangible and important elements to ensure high quality care,” said study co-author David Stevenson, PhD, a Health Policy professor at Vanderbilt University Medical Center. “Anyone who has ever set foot in a nursing home knows how important it is to have sufficient staffing, something the research literature has affirmed again and again. As soon as these new data became available, researchers and journalists started investigating them, and the government now uses the PBJ data in its quality rating system.”

“We found that the newer payroll data showed lower staffing levels than the previous self-reported data,” said Grabowski. “The lower levels in the PBJ data likely reflect both the fact that they are based on payroll records as opposed to self-report, and also that staffing levels were abnormally high around the time of the inspection. In fact, the PBJ data clearly show this bump, followed by a return to normal after inspectors leave.”

The new PBJ data offer a more transparent and accurate view of nursing home staffing, and Grabowski is hopeful future research will be better positioned to understand the implications of staffing fluctuations on residents’ well-being. Further, he noted that “these new staffing data also offer tools for regulators and other oversight agencies to monitor what nursing homes are doing day in and day out.”

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