South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

ChicoER.com had an article about consumer advocate watchgroups concerned about  Assembly Bill 1629, which changed how nursing homes are paid and provided them with higher payments. The workgroup held a number of meetings. Its efforts were overseen by the state Department of Health Care Services, which was supposed to issue a report to the California Legislature last March.  The workgroup included members representing nursing home owners, the SEIU, the watchdog group California Advocates for Nursing Home Reform (CANHR), senior citizens groups and others.

Requiring more nurses to be on duty in nursing homes is key to improving care.  Nursing homes are required to provide at least 3.2 hours of nurse staffing per patient per day. Some want the minimum raised to 3.5 hours.

Each member of the workgroup produced a list of recommendations for improving care at nursing homes. SEIU and CANHR both recommended raising the minimum nurse staffing level from 3.2 to 3.5 hours.

The union wrote that plans should be made, also, for how to reach the staffing level of 4.1 hours that some experts have recommended.

CANHR recommended that nursing home rate increases should depend on homes' meeting the 3.2-hour minimum.   "We don't think they should be granting any rate increases to homes that don't meet 3.2," said Mike Connors, a CANHR advocate who served on the workgroup.

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The AARP published a study of Tennessee nursing homes. They concluded that as staffing levels increased, the number of lawsuits against the facility dropped dramatically.  This seems obvious but nursing homes still only staff to the minimum levels anyway.   The report also concludes that tort restrictions on damages or caps does not increase the quality of care.  In other words, the savings that the nursing homes get with tort reform are not passed on to the residents but rather go into the pockets  of the corporate owners as profit.   Here is the link to the report.

We have also uploaded it here www.scnursinghomelaw.com/uploads/file/qualitynursinghomereporttn2009.pdf

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Alliance for Retired Americans had an interesting report in June 2002 titled Nursing Home Care: When Will We Get It Right .  It has some great information and meaningful recommendations on how to improve care provided in america's nursing homes.  Specifically, the report addresses staffing levels and how staffing affects the quality of care provided.  This report should help lawyers, judges, and juries understand the importance of staffing adequately in the nursing home setting with vulnerable residents. 

We have also uploaded the testimony of Toby Edelman who is a Senior Policy Attorney with the Center for Medicare Advocacy, a private, non-profit organization that provides education, analytical research, advocacy, and legal assistance to help older people and people with disabilities obtain necessary health care.   Since 1977, Toby Edelman has represented and worked on behalf of nursing home residents.  He also explains the correlation between adequate staffing and quality of care.

See also U.S. Department of Health and Human Services' May 2003 Report titled: Staffing Ratios in this annotated review of the literature here.  The purpose of this project is to inform federal and state policymakers about what can be learned about the implementation and enforcement of state minimum nursing staff ratios for nursing homes, and related issues, such as labor shortages and resident casemix. The experiences of states that have already grappled with the complexities of setting, monitoring, and enforcing minimum staffing ratios could be instructive. The project will describe the states’ minimum ratios and their goals, the issues states confront as they implement the ratios, and the perceived impacts of these ratios on the quality and cost of nursing home care.

The study took a two-pronged approach to determining what is currently known about state minimum nursing staff ratios and their implementation. The first was an annotated review of the published and unpublished literature on state standards. The purpose of the literature review was to identify states with minimum nursing staff ratios and to learn howthis type of standard is being implemented. This paper provides the annotated review ofthe literature.

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Newsday ran a story from the Hartford Courant about how states relying on nursing home chains raise concerns about quality of care provided to the residents.

The article states that large, for-profit chains nursing home chains dominate Connecticut's market, according to an analysis of federal data released Sunday by the Hartford Courant. Such facilities have lower staffing levels and higher rates of serious patient-care violations than small chains and independently owned homes, according to the newspaper's review.

"Ownership is certainly a factor in quality of care," Toby Edelman, senior policy attorney with the nonprofit Center for Medicare Advocacy, told the Courant.

He said many of the larger chains have complex organizational structures with multiple layers of management. "They send a lot of money to their corporate offices," he said. "There can be a lot of distance between the owners and the facilities themselves. They're not on the ground."

The Courant looked at two years of inspection and ownership data from the federal Centers for Medicare and Medicaid Services for the more than 240 licensed nursing homes in Connecticut.  Adjusted for size, homes owned by large chains provided, on average, 16 percent fewer registered and licensed nurses than small-chain and independent nursing facilities, according to the data.

The state's large-chain homes had a 30 percent higher rate of causing patients harm or putting them in immediate jeopardy, the Courant determined. For the five large chains in Connecticut, which control about one third of the state's nursing home beds, such serious deficiencies occurred at a 42 percent higher rate than at homes not controlled by large chains.

Information from: The Hartford Courant, http://www.courant.com
 

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The Courier-Journal in Kentucky has a great article about the necessity to increase staffing at nursing homes, and how the nursing home industry lobbyists are fighting against it so their profits remain large despite the poor care that is guaranteed with low levels of staff.  Please read the entire article and the Comments from other interested people.  Below is a summary of the article.

Lois Pemble said she once found her mother alone, sprawled on the floor of her nursing home room, where she'd fallen.   On other occasions, Pemble found her mother with her clothes soaked in urine, waiting for help to get to the bathroom.   She has joined with Kentuckians for Nursing Home Reform in pushing a bill that would require Kentucky to join 37 other states in setting minimum standards for the number of caregivers in nursing homes.

House Bill 109 would require nursing homes to have one nurse's aide for every nine residents during the day shift; one aide per 13 residents during the evening shift; and one aide for every 19 at night.   The bill also would increase the number of RNs required to be on duty -- currently the law requires only that one RN be on duty for only eight hours a day and that one licensed practical nurse be on duty the rest of the time.

The bill would require one nurse for every 21 residents in the day; one for every 29 on the evening shift; and one for every 42 residents overnight.

Other than requiring that a nurse be on duty, Kentucky law now says only that a "sufficient" number of staff be on hand to care for residents, but it does not define "sufficient." 

The reasonable measure already has encountered opposition from the industry, which has contributed more than $110,000 to lawmakers' campaigns, according to records from the Kentucky Registry for Election Finance.  The political action committee of the Kentucky Association for Health Care Facilities has donated $114,150 to lawmakers, and many of the recipients were on key committees or in leadership roles.

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