The Government Accountability Office (GAO) has issued a new report describing nurse staffing levels in nursing facilities and analyzing the relationship between nurse staffing levels, critical incidents (defined as incidents that lead to rehospitalizations or emergency room visits), and Medicare spending for hospital care for nursing home residents who are rehospitalized. The GAO reports, among other findings, that:
- Staffing by registered nurses (RNs) decreases more than 40% in skilled nursing facilities (SNFs) on weekends;
- Less than half of SNFs adjust nurse staffing levels based on resident acuity and need (although required to do so by the “annual facility assessment,” 42 C.F.R. §483.70(e));
- About 24% of SNFs “frequently” (defined as 80% of the time) meet staffing levels identified in a 2001 CMS staffing study; another 26% of SNFs meet those staffing levels “infrequently” (defined as 19% or fewer days); and
- Important staffing information, such as weekend staffing hours and use of agency nurses, is not reported on the federal website Care Compare.
The GAO also finds that although facilities with low RN staffing levels have higher rates of critical incidents, current federal financial penalties for rehospitalizations of residents are too small to encourage higher staffing levels. The GAO writes, “the additional staffing costs they would have to incur (particularly for RN staff) could outweigh the 2 percent reduction in payments” under the federal penalty program.
Facilities with the lowest rates of RN coverage are likely to be for-profit facilities and to be located in the South.
For more information, please go to: GAO, Medicare: Additional Reporting on Key Staffing Information and Stronger Payment Incentives Needed for Skilled Nursing Facilities. GAO-21-408 (Jul. 2021), https://www.gao.gov/assets/gao-21-408.pdf.
August 12, 2021 – T. Edelman