Nursing Homes Struggle to Meet Staffing Minimums

• Nursing homes are struggling to meet staffing requirements introduced by new federal reforms to curb negligence and promote better patient outcomes. 
• Federal nursing home reforms also require financial transparency, which has proven difficult due to overworked reporting agencies and a lack of trained staff.
• In order for nursing homes to properly care for patients full-time they require adequate staffing as that is the largest indicator of adequate care.

Nursing homes are faltering under increased scrutiny from federal agencies over staffing requirements and financial transparency. These reforms attempt to disrupt the common trend of private equity companies purchasing full-time care facilities and treating them as investments rather than sustainable care environments.

The agencies tasked with managing and enforcing these new reforms are also struggling with the same staffing shortages found within the nursing homes, leading to unanswered complaints and continued negligence.

This article will summarize the role of federal agencies working with nursing homes and how these reforms are attempting to improve the system.

Failing to Meet Standards

As part of the current federal administration’s Nursing Home Reforms, states are required to report the percentage of Medicaid payments for certain Medicaid-covered institutional services that are spent on compensation for direct care workers such as nurses and their supporting staff.

However, the Department of Health and Human Services (HHS) claims it lacks sufficient funding to meet federal demands to enforce these reforms. The Department of Health and Human Services receives funding through CMS contracts, which are being called “insufficient” because of uncompetitive salaries and high turnover rates for inspectors.

The Case of Jeremy Herring

Randel Herring recently shared the story of his 30-year-old son Jeremy, who sustained a traumatic brain injury in 2020. He received full-time care at the NorthChase Rehabilitation and Nursing Center in North Carolina.

It was there where Herring noted that the lack of staff was causing his son to live in an unhygienic, unhealthy environment. He found his son lying in his own waste with bedsores.

After filing a formal report with the facility’s administration, Herring received no results and eventually discharged his son to be cared for at home. Complaints like this one are meant to be handled by the federal agency Center for Medicare and Medicaid Services, also known as CMS.

Unfortunately, CMS is also understaffed, which may explain the lack of follow-up on complaints of negligence or abuse. A 2023 report also found that nearly a third of the country’s nursing homes had not had their annual inspection.

This lack of regular accountability only amplifies issues within full-time care facilities, as changes cannot be implemented when problems are unknown.

CMS attempts to create accountability for each state by creating reports of their planned Medicaid spending. The latest report showcases the first fiscal quarter of 2023. Nurses can review this report and see how their state prioritizes funding for family caregiver training, workforce recruitment, workforce training, purchasing personal protective equipment, etc.

These reports do hold long-term value for nurses and legislators wanting to know how Medicaid and Medicare funds are being spent. However, they also showcase the breadth of work CMS is attempting to manage on top of managing nursing home complaints, providing healthcare coverage, and creating information systems.

Severity Fraud

There is some fear that nursing home administrators are encouraged to take on sicker patients to receive higher Medicaid and Medicare reimbursement rates. In 2020, the Saber Healthcare Group paid out $10 million due to claims of falsely placing residents into this higher reimbursement category.

At that time, the Assistant Attorney General stated, “When skilled nursing facilities provide rehabilitation therapy services based on maximizing revenue rather than what is necessary for their patients, we will not hesitate to hold them accountable.” How can this accountability continue if there are not enough inspectors to oversee complaints properly?

CEO of the North Carolina Healthcare Facilities Association, Adam Sholar, attempted to pin this accountability on the nurses, writing, “To suggest that the heroes who provide care to our state’s most vulnerable residents are acting fraudulently is insulting.”

To be clear, nurses are not making these decisions, and nurses are not profiting from this system. Nurses suffer alongside their patients due to understaffing and are forced to make impossible decisions with limited resources.

Ideal Outcomes for Federal Reform

The purpose of the federal administration’s continued pressure for transparency and accountability is an attempt to dismantle a system that prioritizes profits over patients. Ideally, this would lead to nursing homes investing in their patients and local communities, strengthening ties to nursing schools and other healthcare workers.

Nursing homes would regularly receive inspections and address any outstanding complaints in order to increase the quality of care. Financial transparency would allow patients to see what services and innovations each facility is investing in and make more informed decisions about the placement of their loved ones.

This idealism is not without purpose, as goals allow us to see better how systems fail the populations they were made to serve. For nursing homes, utilizing funds to properly staff and retain nurses should be the top priority, as it is the largest indicator of adequate care.

These standards “when applied across all long-term care facilities, would significantly lower the risk of unsafe and low-quality care for residents while being implementable.”

The Bottom Line

Overall, federal nursing home reforms are a step in the right direction toward safe and sustainable full-time care facilities. As agencies like HHS and CMS continue to evolve, so will their ability to properly enforce and maintain the quality of care that Medicare and Medicaid patients deserve. 

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