Articles Posted in Staffing

On February 28, 2022, the White House announced new reform measures to better the quality of care and the safety of skilled nursing facility residents, as well as to “crack down on bad actors” operating nursing homes.   In his State of the Union address, President Biden called on the Centers for Medicare & Medicaid Services (CMS) to set and maintain higher standards for “sufficient staffing” of nursing homes.  CMS is now conducting research to determine the minimum level and type of staffing requirements needed and plans to propose rule changes to existing regulations within the year.  The effect of these policy changes is that skilled nursing facilities may face having federal funding pulled should they refuse to comply with these minimum safety standards.

California long-term care facilities are subject to a number of regulations governing the type, number, and training of staff at facilities caring for elderly adults.  For example, under federal law, a skilled nursing facility “must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.”  (42 C.F.R. § 483.30.)  Similarly, under California law, a skilled nursing facility “shall employ an adequate number of qualified personnel to carry out all of the functions of the facility” (Health & Safety Code § 1599.1(a).)

It is well established that understaffing in nursing homes and assisted living facilities directly lead to substandard care.  Understaffing contributes to and can cause avoidable illness, injury, and death, and is positively correlated with elder abuse and neglect.  However, there is often a conscious decision by managers, directors, and administrators to understaff their facilities, with explicit knowledge that understaffing will negatively impact the overall quality of care provided to residents.  (See, e.g., California Watch, Nursing Homes Received Millions while Cutting Staff, Wages (July 29, 2011).)

The consequences of lack of communication between hospitals and skilled nursing facilities (SNFs) are not new knowledge. According to a 2013 study, in the U.S. alone, more than 5 million patients transition from hospital to SNFs yearly. These transitions heavily rely on the thorough communication of healthcare professionals and paraprofessionals to ensure adequate care for patients. However, hospitals and local SNFs typically operate as separate entities causing a myriad of miscommunication. Communication issues that may happen between the facilities include incomplete, contradicting and/or mismatching verbal and written care plans. These problems may cause SNF staff to delay—or never deliver—proper care for patients, resulting in potentially fatal consequences. For example, noting the wrong medication can cause a stroke patient to relapse into another stroke and an avoidable hospital readmission. While many factors can be used as scapegoats to explain these mistakes, these problems are not new, and as professionals in the field, SNFs should establish better communication and points of accountability before accepting a patient to ensure the dignity and quality of care of patients. A recent study published by the Journal of the American Geriatrics Society by multiple medical doctors have indicated that a significant number of hospital readmissions from SNFs were likely preventable.

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With more than 47 million people worldwide suffering from Alzheimer’s disease and other forms of dementia there is a growing need to identify the cause of these diseases as well as treatments for them. Millions of dollars have gone into the improvement of technologies and the research of brain mapping. At the USC Stevens Neuroimaging and Informatics Institute, Arthur Toga and Paul Thompson have been leading projects that are changing the world of neuroimaging. Toga and his team of researchers are on a quest to use digital imaging to map the brain. They believe that this type of detailed brain mapping will lead to solutions for neurodegenerative diseases such as Alzheimer’s and Dementia. Recent developments have led these scientists closer to the goal of better understanding these diseases and providing a breakthrough in how to prevent them.
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One of the primary concerns for both skilled nursing facilities (SNFs) and hospitals is the high rate of 30-day hospital readmissions and emergency department (ED) transfers by older adult patients.  The Centers for Medicare & Medicaid Services (CMS) recently included these events as short-stay quality measures that will give skilled nursing facilities further incentives to decrease potentially preventable hospital transfers.  Skilled nursing facilities are increasingly pressured by hospitals to decrease 30-day readmissions due to financial penalties to hospitals for specific readmissions and high readmission rates in general.  Moreover, it is imperative that skilled nursing facilities decrease the high number of preventable hospital admissions and emergency department visits due to the increasing number of Medicare advantage patients, accountable care organizations, and combined payment programs.  The skilled nursing facility hospital readmission quality measure that is going to be established in the upcoming years will give further incentives for these facilities to decrease readmission rates.

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As the older adult population in the United States continues to grow, falls continue to be a major concern in the healthcare industry. Frail elderly patients in nursing homes and assisted living facilities are especially vulnerable to fall events, which can greatly increase the risk of morbidity and mortality. Decline in functional status, the amount and kinds of medications, health conditions, impairments in vision and hearing, cognitive status, the reliance on adaptive equipment (such as canes, walkers, and wheelchairs), and restraints are all significant risk factors for falls in the care facility. Patients who are newly admitted into a nursing home are especially vulnerable to falls—an unfamiliar environment coupled with unfamiliar staff makes fall risk identification and management more difficult in this patient population. Moreover, these newly admitted patients have often suffered from a recent acute care event, thus increasing their risk of falls due to debilitated functional ability.

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Linda Boly, 59, a registered nurse who had been unjustly terminated by Legacy Good Samaritan Medical Center for complaining to management that cost-cutting measures were putting patients at risk, was awarded $3 million last Friday by a Portland jury.  Linda reported feeling vindicated by the verdict and hopied that this sends a “big message” to Legacy Health System that hastily pushing patients through process jeopardizes them.

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Far too many nursing homes are experiencing an extreme shortage of staff that has diminished the quality and safety of care for their elderly and disabled. Frailty and dependency on nursing home staff is prevalent among residents who not only need assistance in performing basic activities of daily living, but also monitoring of their progressively complicated medical issues. Unfortunately, many nursing homes have not hired the necessary number of staff to meet their residents’ needs.

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According to the Center of Disease Control and Prevention, there are a total of 16,100 nursing homes in America with approximately 1.5 million patients residing in these facilities. Due to the rapidly growing baby boomer generation, the number of patients residing in these facilities is bound to increase. Although a majority of families conduct an abundant amount of research to ensure their loved ones are in a facility that guarantees them adequate quality of care; NBC news recently discovered that many “government official” websites have false information regarding staffing levels and skilled nursing facilities. According to NBC news, “Staffing levels reported by thousands of nursing homes on a widely-used government website were higher than the staff levels calculated by the Center for Public Integrity through an analysis of annual financial reports submitted by the homes, suggesting that consumers in those facilities may not be getting as many hours of skilled care as they expect.” Many nursing homes inflate the amount of staffing and individual resident care available to gain residents and increase profits at the expense of patient care. Continue Reading

Over 3.4 million nurses are employed at various healthcare facilities throughout the United States. Although, a commendable and necessary profession, low wages, coupled with a stressful work environment, leads to an exceedingly high turnover rate in the nursing industry. Most nurses work extensive shifts and are consumed with tedious work involving the well being of their patients. Numerous nurses feel that with more control over the diagnosis and treatment of the patient along with a more suitable work environment, the rate of replacement will decrease significantly within the nursing community. Continue Reading

Elderly residents of nursing homes and hospitals are often victims of falls and related injuries. As such, one bad fall can significantly lengthen a patient’s hospital stay, which can increase the risk of further complications, as falls can lead to broken bones and even death. However, these occurrences are highly preventable with adequate staffing and fall prevention procedures. Safety experts even state bad falls are events which should never take place inside protective settings such as hospitals.

Currently, 39 states do not require hospitals to report instances of falls that occur within their facilities. However, many states, such as California, require hospitals to report incidences of falls that occur within the hospital to the state health department. Some hospitals have begun moving toward the implementation of more fall prevention methods, and they have proven to be very successful. For example, an increased movement towards patient safety and fall prevention occurred in Washington, when around 90 people fell victim to injuries and death due to falls last year.

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