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Nursing Home Quality Assessment Expected to Improve by 2016

A recent study by Families for Better Care revealed that Illinois ranks as the eighth-worst in the nation for nursing home care, reflecting particularly low levels of staffing per patient. Especially given an expected “silver tsunami” of increased need for elderly care as baby boomers age, individuals affected by nursing home abuse and neglect will increasingly look to federal assessment mechanisms such as on-site inspections and federal reporting to ensure that nursing homes are complying with federal and state requirements. In theory, staffing levels reflect the amount of direct care time provided to a patient, so that inspectors and the general public can evaluate a given nursing home.

However, annual inspections have been decreasing and federal data reporting may be inaccurate. Between 2008 and 2012, state nursing home inspections dropped by 6%. These inspections, which provide data for the federal government’s Nursing Home Compare site, are susceptible to inflation of reported staffing levels. According to a recent report by the Center for Public Integrity, one nursing home executive was reported as admitting that “staffing hours will be a little high this week but will drop the following week.” Even if the self-reported data is not inflated, Nursing Home Compare currently conflates nursing staff directors and direct care nurses, which means that its staffing level estimates may not accurately reflect direct care time.

The Better Approach

Instead, analyzing staff levels using payroll data reported to Medicaid can provide more accurate quarterly reports based on financial data which the Centers for Medicare and Medicaid Services has referred to as the “gold standard.” Rather than relying on self-reported statistics with limited inspections, payroll data closely tracks the number of hours worked, and whether the employee is providing direct care to a patient. Under a provision of the Affordable Care Act, the federal method of recoding nursing home staffing levels was supposed to transition from self-reported data to more accurate payroll data by March of 2012.

However, fiscal constraints prevented timely implementation of the improved assessment metrics. For example, a pilot program which attempted to collect the payroll data from 1,000 nursing homes only successfully obtained results from 120 homes. The payroll data obtained as of 2012 revealed more than 700 nursing homes, including 250 facilities in Illinois, that failed to meet the federally- and state-mandated staffing levels.

Successfully shifting to the proposed alternative metric would enable increased federal oversight, and efforts continue to implement the system. In October of 2014, bipartisan legislation authorized $11 million in funding to ensure implementation of the payroll system by 2016. The new system will also provide analysis of a broader spectrum of quality assurance factors, such as percentage of residents on anti-psychotic medication, percentage of residents discharged from the facility, staff turnover, and more personalized data on each individual resident.

These improvements in federal assessment procedures could reveal violations of state or federal staffing level requirements. Nursing homes that are understaffed increase the risk of abuse and neglect. If you or your family members have been affected by nursing home abuse and neglect, please contact your experienced Chicago nursing home abuse and neglect attorney to learn more about the role of decreased staffing levels.

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