New Federal Requirements Target Understaffing in Nursing Homes

“Since nurse staffing is directly related to the quality of care that residents experience, CMS is very concerned about the risk to resident health and safety that these situations may present.”
-11/18/18 CMS memo to state nursing home surveyors


The Centers for Medicare & Medicaid Services (CMS), the federal agency tasked with regulating nursing homes, has updated rules for nursing home staffing levels and how they report employee hours.

In a November 30th memo distributed to State Survey Agency Directors and the public, CMS said that staffing data now obtained through the Payroll Based Journal (PBJ) reporting system has raised red flags over the true level of staffing in nursing homes across the country. Specifically, federal regulators were alarmed by the number of facilities who allow multiple days to pass without a registered nurse on site. Current federal rules state that a nursing home must have an RN on site 7 days a week for eight consecutive hours a day.

New Staffing Reporting System Shows Majority of Nursing Homes Lied About Staffing

In April of this year, data from the PBJ reporting system began being used by CMS to rate nursing homes on Nursing Home Compare. News outlets quickly seized on the discrepancy between staffing hours under the previous self-report model and the official data coming through the payroll-linked PBJ system. Their finding? The New York Times found that 7 out of 10 nursing homes had lower staffing numbers than they had under the self-report model.  Kaiser Health News found that for-profit nursing homes had lower staffing ratios than non-profits and that weekend staffing was especially low.

Many nursing homes had clearly been giving CMS inaccurate staffing data and even worse, many nursing homes were using deceptive staffing tactics. Previously, nursing homes only had to submit staffing data for the two weeks before an inspection. In what is perhaps the worst kept secret in the nursing home industry, administrators, aware an inspection was about to happen, “staffed up” in order to strengthen the data they submitted to state surveyors upon their visit.

In July, now aware of the deception of many nursing homes, CMS implemented a new rule that punishes nursing homes who go more than 7 days in a quarter without an RN on site. Nursing homes who go more than 7 days per quarter without an RN on site will automatically receive just 1 (out of 5) stars for staffing on Nursing Home Compare.


Memo Outlines Policies to Address Low or No Staffing
The concern over low staffing has forced CMS to clarify their rules on reporting hours, as well as a plan to further target nursing homes who understaff on weekends and who fail to have an RN on site for the appropriate amount of time. Below are the remedies and clarifications included in last week’s memo.

  1. The previous rule required 10% of health surveys to be conducted either on the weekend or before 8 a.m. or after 6 p.m. The new rule requires half of the 10% to be done only on weekends.
  2. Facilities now have to separate Universal Care Worker Hours. Universal Care Workers are usually CNAs who do double-duty in meal prep or general housekeeping. Now, nursing homes must only report the hours in which they function as a CNA.
  3. CMS will notify state survey agencies of facilities who have an RN less than the required 7 days a week for 8 consecutive hours or particularly low weekend staffing hours, and will require the facility to be cited for a deficiency in this category during regular surveys. 


Deficiencies and Fines Do Little to Create Lasting Change
As nursing home abuse and neglect attorneys committed to protecting the health and safety of the elderly, we are always happy to hear that federal and state agencies are strengthening policies that require better care from nursing homes and rehabilitation facilities. The move to an official staffing reporting system, the PBJ, was the first step in the right direction, pointing out the previous deceit of many nursing homes, and bringing public attention to the need for stronger oversight of nursing home management.

However, citing a nursing home for a deficiency only requires the nursing home remedy the issue by a certain date and/or pay a nominal fine. These punishments have done little in the past to deter bad behavior on the part of nursing homes. It is also concerning that nursing homes are essentially able to self-report universal care worker hours. There is no mention in CMS’ memo of any agency verifying direct patient care hours that universal care CNAs perform.

Levin & Perconti: Chicago’s Legal Voice for Victims of Nursing Home Abuse & Neglect 

If someone you love has been the victim of abuse or neglect in a nursing home, rehabilitation center, or other long or short-term care facility, the nursing home abuse and neglect attorneys of Levin & Perconti want to help you. Our attorneys have nearly 30 years experience successfully bringing nursing homes to task for failing victims and their families, good people who rely on these facilities to care them.

With over half a billion dollars recovered for our clients, our attorneys are committed to bringing justice to families whose loved ones have been harmed by careless nursing homes. Please, contact us now for a FREE consultation at 312-332-2872 in Chicago, toll-free at 1-877-374-1417, or by completing our online case evaluation form. 












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