President Biden Calls On Medicare To Set Higher Staffing Standards For Skilled Nursing Facilities

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).)

California courts have further emphasized that resident-patients have “the right to reside in a facility with an adequate number of qualified personnel to carry out all of the functions of the facility.”  (Shuts v. Covenant Hold Co. LLC (2012) 208 Cal App. 4th 609, 615.)  A facility’s conscious understaffing and poor training amounts to elder abuse, not just mere negligence.  (See, e.g., Merron v. Superior Court (2003) 108 Cal App. 4th 1049, 1067 [The defendant hospital’s failure to take remedial action despite having knowledge of complaints of inadequate staffing constituted reckless neglect and material grounds for Plaintiffs’ elder abuse claim.]; See also Fenimore v. Regents of the University of California (2016) 2016 Cal. App. Lexis 231.)  In Fenimore v. The Regents of the University of California, the Second District Court of Appeal held that allegations that a defendant’s facility was understaffed at the time an elderly patient fell, that the understaffing caused the patient’s harm, and that this understaffing was part of a pattern and practice, is sufficient to plead a viable theory of Elder Abuse based on recklessness.

Given the robust relationship between understaffing at facilities and quality of care, it is clear that the corporate or administrative decisions to understaff a facility amounts to reckless and malicious conduct that disregards a serious danger to elderly and dependent adults. “The President has outlined a path forward to improve conditions for both nursing home residents and the staff who care for them,” stated CMS Administrator Chiquita Brooks-LaSure. “CMS is ready to implement this vision and at the foundation is the establishment of minimum standards for staffing in nursing homes.”

Yeroushalmi Law is dedicated to holding nursing homes accountable when understaffing results in patient injury.  If you believe that you or a loved one is a victim of such neglect, do not hesitate to contact us for a free consultation.

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