By Amy M. Collins, managing editor
Recently, the Association of Health Care Journalists (AHCJ) released updated nursing home inspection data, which is “derived from a large file that is split up for easier use by members.” (Members get a data set containing three years of the most severe deficiencies found during inspections, as well as current ratings assigned by the Centers for Medicare and Medicaid Services
A news release put out by AHCJ based on their analysis of these ratings isn’t pretty. The latest number of deficiencies recorded by the CMS (which range from “isolated incident of actual harm” to “widespread immediate jeopardy to resident health or safety”) has reached 16,806.
Medicare ratings themselves have also been called into question in a recent article suggesting that nursing homes with the highest ratings may be gaming the system. Despite these ratings being the gold standard in the industry, the data they are based upon on is largely self-reported by the nursing homes and not verified by the government. Often, details such as fines and other enforcement actions by the state, as well as complaints filed by consumers with state agencies, are left out.
Could part of the problem be there aren’t enough nurses in nursing homes? An article in the New York Times states that, in evaluating Nursing Home Compare, the American Association of Nurse Assessment Coordination estimates that at least 11.4% of nursing homes don’t have RNs available around the clock (since data is self-reported, this could be higher). Yet studies show that care is improved when there are more RNs in nursing homes. (We published a 2005 original research study that found that increasing the amount of time that RNs spend with long-stay nursing home residents reduces pressure ulcers, hospitalization, and urinary tract infections.)
Anecdotally, I can say that I am sometimes dismayed by what I’ve seen in the nursing homes my grandmother has been in. There always seems to be a lack of staff—and with so many residents these days suffering from varying levels of dementia and memory problems, staff are needed more than ever. I’ve spoken with nurses and nurses’ assistants working in these homes, and staff-to-resident ratio is always a common complaint of those working there. In my grandmother’s current home, residents are piling in by the dozen, while the number of staff seems to remain the same.
In addition, several cousins of mine who work as nurses in nursing homes have told me that one of the biggest problems they face is staffing—they see residents sitting around all day losing mobility because there aren’t enough people to watch them and encourage them to get up out of their chairs.
According to the same Times article, Representative Jan Schakowsky (D-IL) has introduced the Put a Registered Nurse in the Nursing Home Act, which would require a direct-care nurse on site 24 hours a day, seven days a week, in any nursing home that receives Medicare or Medicaid reimbursement. If passed, this might help address some of the deficiencies at these homes, but I also think more staff in general, such as CNAs, are needed if nursing home residents are to get the care they need. The decision to move a loved one into one of these homes is, after all, made in order to keep them safe.