Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations

Geng, Fangli; Stevenson, David G.; Grabowski, David C.

doi:10.1377/hlthaff.2018.05322

Cited by 111 publications

(100 citation statements)

References 3 publications

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“…The RN and other nurse staffing levels were calculated based on daily resident census and the CMS Payroll‐Based Journal system that allows nursing homes to submit electronically the number of hours that care workers (including agency and contract staff) are paid to work each day 26 . As required by Section 6106 of the Affordable Care Act, the payroll‐based data are submitted quarterly on different types of nursing staff and subject to audit to ensure accuracy.…”

Section: Methodsmentioning

confidence: 99%

COVID‐19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates

Temkin‐Greener

Gao

et al. 2020

J American Geriatrics Society

188

221

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BACKGROUND/OBJECTIVES To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with 2019 coronavirus disease (COVID‐19) confirmed cases and deaths by April 16, 2020, among Connecticut nursing home residents. DESIGN Cross‐sectional analysis on Connecticut nursing home (n = 215) COVID‐19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two‐part models determined the associations of key nursing home characteristics with the likelihood of at least one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death). SETTING All Connecticut nursing homes (n = 215). PARTICIPANTS None. INTERVENTION None. MEASUREMENTS Numbers of COVID‐19 confirmed cases and deaths among residents. RESULTS The average number of confirmed cases was eight per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least one confirmed case, every 20‐minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio [IRR] = .78; 95% confidence interval [CI] = .68–.89; P < .001); compared with one‐ to three‐star facilities, four‐ or five‐star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78–.97; P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02–1.32; P = .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03–1.29; P = .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20‐minute increase in RN staffing significantly predicted 26% fewer COVID‐19 deaths (IRR = .74; 95% CI = I .55–1.00; P = .047). Other focused characteristics did not show statistically significant associations with deaths. CONCLUSION Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.

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Section: Methodsmentioning

confidence: 99%

COVID‐19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates

Temkin‐Greener

Gao

et al. 2020

J American Geriatrics Society

188

221

View full text Add to dashboard Cite

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“…12 Similarly, in a comparison of facility-reported staffing data with potentially more objective payroll-based data, Geng et al found discrepancies and evidence of manipulation around surveyor visits. 38 Given this context and our results, other MDS-based measures should also be assessed for accuracy.…”

Section: Comparisons Between Reporting Rates Of Different Mds Itemsmentioning

confidence: 96%

“…First, claims-based measures may be useful supplements or replacements for the MDS-based patient TA B L E 2 National reporting rates of major injury falls by race and short-vs. long-stay in 2011-2015 This would be consistent with CMS's move toward payroll-based staffing data for NHC, which are likely more reliable than the previous self-reported source. 38 Second, it may be possible to make model-based corrections of MDS reporting rates based on nursing home characteristics and history. Finally, both claims data and models such as the one we developed may be used for automatic and targeted auditing.…”

Section: Comparisons Between Reporting Rates Of Different Mds Itemsmentioning

confidence: 99%

Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare

Sanghavi

Pan

Caudry

2019

Health Services Research

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Objective To assess the accuracy of nursing home self‐report of major injury falls on the Minimum Data Set (MDS). Data Sources MDS assessments and Medicare claims, 2011‐2015. Study Design/Methods We linked inpatient claims for major injury falls with MDS assessments. The proportion of claims‐identified falls reported for each fall‐related MDS item was calculated. Using multilevel modeling, we assessed patient and nursing home characteristics that may be predictive of poor reporting. We created a claims‐based major injury fall rate for each nursing home and estimated its correlation with Nursing Home Compare (NHC) measures. Principal Findings We identified 150,828 major injury falls in claims that occurred during nursing home residency. For the MDS item used by NHC, only 57.5 percent were reported. Reporting was higher for long‐stay (62.9 percent) than short‐stay (47.2 percent), and for white (59.0 percent) than nonwhite residents (46.4 percent). Adjusting for facility‐level race differences, reporting was lower for nonwhite people than white people; holding constant patient race, having larger proportions of nonwhite people in a nursing home was associated with lower reporting. The correlation between fall rates based on claims vs the MDS was 0.22. Conclusions The nursing home‐reported data used for the NHC falls measure may be highly inaccurate.

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“…Many nursing home staff are making close to minimum wage, and nursing homes around the country were experiencing staff shortages even before COVID-19. 80 We also need to make certain that increases in payments go to direct caregivers through approaches like wage floors or wage pass through programs. Moreover, staff need to have full benefits like health insurance and nonpunitive sick leave.…”

Section: Learning From the Crisis And Reshaping The Futurementioning

confidence: 99%

COVID‐19 in Nursing Homes: Calming the Perfect Storm

Ouslander

Grabowski

2020

J American Geriatrics Society

Self Cite

265

269

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The pandemic of viral infection with the severe acute respiratory syndrome coronavirus-2 that causes COVID-19 disease has put the nursing home industry in crisis. The combination of a vulnerable population that manifests nonspecific and atypical presentations of COVID-19, staffing shortages due to viral infection, inadequate resources for and availability of rapid, accurate testing and personal protective equipment, and lack of effective treatments for COVID-19 among nursing home residents have created a "perfect storm" in our countryʼs nursing homes. This perfect storm will continue as society begins to reopen, resulting in more infections among nursing home staff and clinicians who acquire the virus outside of work, remain asymptomatic, and unknowingly perpetuate the spread of the virus in their workplaces. Because of the elements of the perfect storm, nursing homes are like a tinderbox, and it only takes one person to start a fire that could cause many deaths in a single facility. Several public health interventions and health policy strategies, adequate resources, and focused clinical quality improvement initiatives can help calm the storm. The saddest part of this perfect storm is that many years of inaction on the part of policy makers contributed to its impact. We now have an opportunity to improve nursing homes to protect residents and their caregivers ahead of the next storm. It is time to reimagine how we pay for and regulate nursing home care to achieve this goal.

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Daily Nursing Home Staffing Levels Highly Variable, Often Below CMS Expectations

Cited by 111 publications

References 3 publications

COVID‐19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates

COVID‐19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates

Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare

COVID‐19 in Nursing Homes: Calming the Perfect Storm

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