July 11, 2018
Care Center Staffing Ratings Under Scrutiny
On July 10, 2018 by Jodi Boyne
The New York Times recently published an article (‘It’s Almost Like a Ghost Town.’ Most Nursing Homes Overstated Staffing for Years. July 7, 2018) that calls into question staffing levels in nursing homes. The article cites data analyzed by Kaiser Health News that nursing homes submit to the Centers for Medicare & Medicaid Services (CMS) each quarter via the Payroll-Based Journal (PBJ) system, as well as staffing data that facilities previously submitted annually using the CMS-671 form.
Among other information, the article links to a map of the U.S., with data showing ratios of residents-per-aide and residents-per-nurse at high and low points, in order to show that staffing can fluctuate at an individual facility over time.
While Minnesota nursing homes are staffing higher on average than facilities nationwide and on average are earning more than 4 of 5 possible stars for staffing, the article could raise questions and concerns regarding staffing levels. We are monitoring media outlets in Minnesota to see whether they NY Times story or Kaiser Health News assessment will get additional coverage.
LeadingAge Minnesota Response
The NY Times has helped raise awareness of an issue we are acutely aware of in Minnesota – workforce challenges in nursing homes.
Minnesota, on average, rates higher than other states in its staffing ratings, and we are proud of the quality care we provide to aging Minnesotans. Quality and safe care requires a person-centered approach that allows for adjustment in staff levels based on the needs of people being served. Every day, aging services providers work in collaboration with doctors, nurses, residents and families to appropriately staff their settings based on individual needs of the residents and the training, experience and capabilities of the care team.
The greater challenge we face in ensuring access to quality care is the ongoing shortage of professional caregivers. There are currently 2,800 open direct care positions in nursing homes across the state, and many nursing homes have made the difficult but necessary choice to decline admissions at certain times due to shortages in essential staff.
LeadingAge Minnesota and its members are actively pursuing many solutions to address our workforce challenges. However, we alone cannot resolve this challenge. With the 65+ population set to double in the next decade, it will take a lot of us working together to serve the needs of our growing senior population. We look forward to continued collaboration with regulators, lawmakers and other stakeholders to elevate the profession of caregiving and ensure quality care and services that seniors deserve and families expect.
Members can download Staffing Concerns in Care Centers for key takeaways from the NY Times article, the LeadingAge Minnesota response, key facts on our workforce challenges, and a summary of activities we are developing and implementing to resolve our workforce challenges.
PBJ TIPS AND RESOURCES:
We also encourage members to refresh their understanding on this important change in how CMS calculates staffing ratings via the PBJ system. Here are two tips and a few resources to help you:
Tip: Review Nursing Home Compare and Check for This Icon --
CMS has added an icon to Nursing Home Compare for facilities that reported 7 or more days in a quarter with no RN hours through the PBJ system. Check your Nursing Home Compare rating to see if the icon appears. If it does, review your Payroll Based Journal submission to confirm that CMS has not made an error in its application of the data for your site.
TIP: Timely & Accurate Reporting
Submitting timely and accurate data is important as CMS will continue to calculate the staffing measures posting to the Nursing Home Compare website to use in the 5-Star Quality Rating System. In an April 2018 memorandum announcing the transition to use of PBJ data for staffing ratings, CMS identified some common errors in PBJ data submission. See the first item in the resource list below to access that memo.
Resources:
CMS Tags Nursing Home Compare Ratings to Reflect On-Site Nurse Coverage (Advantage, June 5)
PBJ Now Being Used to Set Staffing 5-Star Measure (Advantage, May 1)
Care Center Staffing Measures and Ratings to Reflect PBJ Data (Advantage, April 11)