NURSING HOME STAFFING: Red dots indicate the most understaffed homes. New York Times

A new analysis of payroll data by the Kaiser Health News found significant fluctuations in nursing home staffing, particularly on weekends.

The New York Times reports on the findings.

The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends. On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest.

As an expert in the article notes, the basic needs of nursing home residents — bathing, dressing, eating — don’t change day to day. The data on which the study is based is being compiled thanks to the Affordable Care Act, aka Obamacare.

The payroll records provide the strongest evidence that over the last decade, the government’s five-star rating system for nursing homes often exaggerated staffing levels and rarely identified the periods of thin staffing that were common. Medicare is now relying on the new data to evaluate staffing, but the revamped star ratings still mask the erratic levels of people working from day to day.

By the way: The nursing home industry is leading the charge for Issue One on the November election ballot in Arkansas. Issue One, by devaluing the life of an elderly person and limiting attorney fees, will discourage lawsuits against nursing homes for neglect. Issue One also strips the court of rule-making authority. In the event some rule proves damaging to nursing home and other corporate players, the legislature can change it.

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The article comes with a searchable map on the staffing of nursing homes included in the study, a number in Arkansas. Arkansas doesn’t seem to reflect the same concentration of understaffed nursing homes as a neighbor, Texas. That perhaps is related to a reimbursement formula adopted several years ago that has produced healthy profits across the industry in Arkansas, most of which depends on Medicaid reimbursement.

Nursing shortages and the turnover and burn-out because of low pay for aides — the front line of resident care — are cited in the article.

UPDATE: A lawyer friend offers a reason for the cluster of understaffed nursing homes in Texas. There are no legal consequences. He writes:


About 16 years ago, Texas passed caps on non-economic damages. Lawyers no longer sue nursing homes in Texas because they cannot afford to do so. So nursing homes in Texas are basically immune from suit. That is what will happen in Arkansas if Issue One passes.

Here’s an AARP report on Texas nursing homes. It is not a pretty picture.