Nursing home staffing levels often decline on weekends. In November 2018, the Centers for Medicare & Medicaid Services (CMS) identified facilities with low staffing on weekends and directed states to conduct surveys in a portion of these facilities on weekends.[1] Then, in January 2022, CMS began posting weekend nurse staffing levels at nursing homes,[2] in addition to a single staffing measure, citing two reports by the Health and Human Services’ Office of Inspector General about the need for additional staffing information on the federal website Care Compare.[3]
A new study confirms the importance of providing more detailed staffing information to the public. Analyzing staffing levels at 14,499 nursing facilities in 2017 and 2018, researchers found that daily variation in nurse staffing levels (registered nurses (RNs) and certified nurse assistants (CNAs)), which they describe as “instability of staffing levels,” negatively affects quality of care for residents.[4] They note that although consumers recognize the importance of staffing hours in general, they may not understand that daily staffing variability is also associated with quality. They explain why:
Everyday tasks, such as medication administration and monitoring, can be adversely affected by both inadequate staffing and a lack of stability in staffing availability. During low staffing days, when residents do not receive needed care, they are more likely to develop various conditions, such as pressure injuries, because staffing was not sufficient to rotate them in bed; exacerbation of wounds when staff is not available to change dressings in a timely fashion; falls with injuries without consistent daily attention to anticipating needs, such as requiring assistance in getting to the bathroom. Most of these consequences of short staffing cannot be fixed by additional staff on other days: more turning or toileting on extra-staffing days cannot eliminate the fall or the wound development that occurred when understaffed.
The researchers find that for-profit nursing facilities, especially those owned by chains, have less stable staffing levels than other facilities.
March 23 – 2022 – T. Edelman
[1] CMS, “Payroll Based Journal (PBJ) Policy Manual Updates, Notification to States and New Minimum Data Set (MDS) Census Reports,” QSO-19-02-NH (Nov. 30, 2018), https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO19-02-NH.pdf
[2] CMS, “Nursing Home Staff Turnover and Weekend Staffing Levels,” QSO-22-08-NH (Jan. 7, 2022), https://www.cms.gov/files/document/qso-22-08-nh.pdf
[3] Office of Inspector General, “Some Nursing Homes’ Reported Staffing Levels in 2018 Raise Concerns; Consumer Transparency Could Be Increased” (Data Brief), OEI-04-18-00450 (Aug. 20, 2020), https://oig.hhs.gov/oei/reports/OEI-04-18-00450.pdf; Office of Inspector General, “CMS Use of Data on Nursing Home Staffing: Progress and Opportunities To Do More,” OEI-04-18-00451 (Mar. 2021), https://oig.hhs.gov/oei/reports/OEI-04-18-00451.pdf
[4] Dana B. Mukamel, Debra Saliba, Heather Ladd, R. Tamara Konetzka, “Daily Variation in Nursing Home Staffing and Its Association with Quality Measures,” JAMA Open Network (Mar. 14, 2022), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790046