In an accompanying post, we covered a recent Center for Public Integrity investigation that revealed how a federal website administered by the Centers for Medicare and Medicaid, called Nursing Home Compare, has not been accurately reporting staffing levels at nursing homes across the country. This was due to a reliance on information self-reported by facilities rather than Medicare reports that reflect more accurate staffing levels. In some cases homes were self-reporting more than double their actual staff level, and the problem is particularly pronounced in many southern states.
Such discrepancies thus led to inaccurate reporting on the Nursing Home Compare website, which is meant to provide information on nursing homes such as ratings, investigation-related information, and staffing levels for consumers to use in searching for the right facility. The Center for Public Integrity investigation also revealed that staffing levels were particularly lower in nursing homes that served minority communities of residents.
The CPI Report
The Public Integrity report revealed how majority-white nursing homes have about 34% higher staffing levels than facilities with mainly black residents, and how those same homes had an even more astounding and disturbing 60% higher staffing level than nursing homes mainly comprised of Latino residents. According to the statistics, “[h]undreds of majority-black homes” nationwide reported through Nursing Home Compare that their registered nurses provided on average just over 30 minutes of care time to each resident every day. However, according to the Medicare reports, this figure was really only about 20 minutes per day. In Latino homes in Texas cities, the average time spent on care per day was only a dismal 10 minutes.
As was reported with regard to the general discrepancies in reporting accuracy being most pronounced in southern states, the racial discrepancies in the data for the black nursing home resident community were particularly notable in the Midwestern states. Illinois, Michigan and Wisconsin nursing homes had major differences in care time for white residents versus black residents. As far as cities are concerned, Chicago and Houston are among the major metropolitan areas with such differentials (in areas where at least five nursing homes had majorities of black residents). As evidence of a control for the empirical research into the differing care levels, the differentials occurred even in situations where residents between the white, black and Latino homes were “equally sick and poor” and thus all in theory would require the same amount of attention, yet the white residents received far, far more. Even more interesting, the facilities with majority black and Latino populations were almost all for-profit homes, and had higher resident populations than the white homes that still had more staffing and care time.
As the article mentions, cites a history of relevant study and literature, nursing home staffing levels have a correlation with the “quality of care and health outcomes,” and that a lack of care and attention can end up resulting in harsher consequences for residents’ health. It is so far unclear where the law comes into play here. For one, Title VI of the Civil Rights Act bars racial and other discrimination by nursing homes and other providers that accept Medicare and Medicaid funds. As with anything, accepting federal dollars means obeying federal laws and regulations. Yet so far it is unclear, according to CMS, whether this data indicated such unlawful racial discrimination. Furthermore, there is a lack of federal regulations requiring a minimum staffing level at homes receiving federal money, so there is no regulatory structure to lean on. It is no shock that facilities in general reduce staff to reduce overhead and make more money at the expense of its residents’ care, but it is even more egregious where different racial communities receive differing levels of care.
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