Tuesday, December 21, 2021

SNF Staffing Standards-New Report

Yesterday I blogged about California's consideration of tying Medicaid funding for SNFs to certain quality of care benchmarks. Today I wanted to let you know about a new report released by the National Consumer Voice for Quality Long-Term Care. State Nursing Home Staffing Standards SUMMARY REPORT opens noting that

"Chronic understaffing has been a serious problem in nursing homes for decades and has been exacerbated by the COVID-19 pandemic. While there are numerous factors contributing to this problem, one major cause is the lack of adequate minimum staffing standards at both the state and federal levels. Minimum standards ensure that staffing will not fall to a level that would be harmful to residents. Local, state, and national advocates have pushed for minimum staffing standards for years. Knowledge of the range of state staffing requirements can be very useful in these efforts. To that end, the focus of this summary report is to present staffing requirements from each state and analyze how they compare to each other and to levels recommended by research conducted for the federal government. This information can also be helpful to policymakers, researchers, and the media.

The report discusses the connection between staffing and quality care, the research on minimum staffing standards, laws and regs at both state and federal levels, an analysis of state staffing standards, recent developments, and concludes with this

Twenty years after the CMS study found that at least 4.1 hprd of direct care nursing staff time are needed just to prevent poor outcomes, state staffing requirements, with a few exceptions, are nowhere near that recommended level. Only the District of Columbia requires this overall level of staffing, and only six states mandate the presence of a registered nurse 24 hours a day regardless of facility size. Despite what is known about the relationship between staffing levels and quality care, staffing standards in almost every state remain severely low. Residents have waited decades for adequate staffing around the clock. Every day that passes without sufficient staffing jeopardizes their health, safety and welfare. Ongoing and robust advocacy is needed at both the federal and state levels to provide residents with the care to which they are entitled and that they deserve.

The full report is available here, a summary here, Appendix A (guide to state staffing standards) here, and Appendix B (state staffing standards comparison) here.


Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, State Statutes/Regulations | Permalink


There wasn’t a place to respond to yesterday’s blog post about the high percentage of Covid deaths in SNF’s. I asked a leader in LeadingAge during a Zoom presentation months ago if the death statistics in LTC facilities were adjusted for DNRs. His answer: no. I think there might be a major impact on death statistics if the DNR factor were brought in, but how would we know?
Regarding this particular article ….. this country is going to need to import labor of all types, with custodial care being a HUGE need coming down the pike as the babyboomer generation reaches the end of its run. If the facilities catering to the “private pay” folk can’t fill job openings, how are the facilities dependent on less-than-adequate government reimbursements going to stay open? (As an aside, I worked for a manufacturer who sold some of its products to the government. Even when the government agrees to the product price, it’s a notorious slow payer, something that impacts cash flow.)
I dabbled in selling Long Term Care insurance in the mid-90’s. A notable attitude I faced was, “I’ve been a taxpayer all my life. Let the government take care of me when it comes to it – if it means wards versus a semi-private room, what will I care? ---- I’ll more than likely be “out of it” and won’t know the difference."
Remember when orphanages were the answer to wards of the state, until individual foster care for children became the perceived solution? Well, SNFs full of Medicaid patients are the end-of-life equivalent. Prepare for large wards with many confined to dirty beds.

Posted by: Jennifer J Young | Dec 22, 2021 7:23:31 AM

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