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Nursing homes: Too many facilities severely understaffed before COVID-19

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Fri, May 22nd 2020 03:10 pm

By the Long Term Care Community Coalition

In times of crisis, sufficient staffing is critical to a nursing home’s ability to care for residents. In the months leading up to the coronavirus pandemic, however, most facilities failed to maintain sufficient staffing to meet every resident’s needs, according to the newest federal nursing home data (fourth quarter of 2019).

Earlier this week, LTCCC announced the publication of the latest user-friendly data on staffing for every U.S. nursing home (in compliance with mandatory reporting requirements). This information can help the public, news media, and policymakers identify and assess the extent to which nursing homes in their communities provided sufficient staffing to meet basic clinical and quality of life needs. The data are for the most recent period reported by the federal Centers for Medicare & Medicaid Services (CMS).

Visitors to our website, www.nursinghome411.org, can download easy-to-use files for every state that include:

  • The levels of care staff that a facility has for its residents;
  • Staffing levels for important non-nursing staff, including administrators and activities staff; and
  • The extent to which the facility relies on contract workers to provide resident care.

The individual state files are easily sortable to facilitate ease of use. For example, a state file can be sorted to identify which facilities have the highest and lowest reported levels of certified nursing assistant (CNA) care.

Our report also includes staffing averages and rankings for all states (including Washington, DC). A few facts about the reported data:

√ The latest data indicate that US nursing homes provide an average of 3.37 total care staff hours per resident day (HPRD) and 0.42 RN HPRD, the same levels recorded the previous quarter (Q3 2019). The national averages are well below the amount of time needed to ensure that residents receive sufficient clinical care (4.10 HPRD and 0.75 RN HPRD), as indicated by a landmark 2001 federal study.

√ The top 10 states for total staffing: Alaska, Hawaii, North Dakota, California, DC, Florida, Oregon, Idaho, Maine and Delaware.

√ The bottom 10 states are: Missouri, Texas, Oklahoma, New Mexico, Illinois, Indiana, South Dakota, Kansas, Nebraska and Iowa.

Note: Nursing home facilities are prone to significant fluctuation in staffing and often have very low staffing on specific days such as weekends and holidays. Though our report accounts for staffing fluctuations by averaging all observations, data on staffing for specific days can be found by searching for a nursing home in the CMS dataset, https://data.cms.gov/Special-Programs-Initiatives-Long-Term-Care-Facili/PBJ-Daily-Non-Nurse-Staffing-CY-2019Q4/aif9-utfe.

Coronavirus has resulted in more than 30,000 fatalities and 150,000 cases in 7,000 long-term care facilities through May 14, according to Kaiser Family Foundation data. As numerous reports have highlighted, staffing shortages have exacerbated issues in facilities nationwide before and during the pandemic. LTCCC will continue monitoring and publishing staffing data as they are reported by CMS in order to inform the public about facility conditions during the coronavirus.

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