nursing home staff

SENATE AGING COMMITTEE HOLDS HEARING
ON NURSING HOME STAFFING

Short-staffing in nursing homes was the subject of a July 27 hearing by the Senate Special Committee on Aging. The hearing, ANursing Home Residents: Short-changed by Staff Shortages, Part II,@ was held four days after The New York Times reported draft findings from a report on nurse staffing by the Health Care Financing Administration. The report, mandated by Congress in 1990, was due January 1, 1992.

Senator Grassley, Chairman of the Senate Aging Committee, opened the hearing by describing HCFA=s report as showing that more than half the nursing homes nationwide fall below acceptable staffing levels. Before legislating minimum staffing levels, he said, two additional pieces of information are needed: the second part of HCFA=s study, which will discuss the cost of implementing minimum staffing requirements, and an analysis of how the nursing home industry spends the money it receives, which the General Accounting Office is currently studying. In the meantime, however, Senator Grassley urged that any Areplenishment bill@ restoring Medicare funding to nursing homes tie increased reimbursement to staffing.

HCFA Administrator Nancy-Ann DeParle said that the draft report shows a strong association between staffing levels and quality care. Facilities that provide less than 12 minutes of registered nurse care, less than 45 minutes of total licensed nurse care, and less than two hours of nurse aide care per resident per day have significantly more problems than facilities meeting those standards. HCFA is now working to adjust minimum staffing requirements by case mix, to expand studies beyond the 2000 facilities in three states (OH, NY, TX), to validate findings with case studies, and to determine the costs and feasibility of minimum staffing requirements.

Senator Grassley asked Ms. DeParle about HCFA=s authority to require staffing standards through rulemaking and/or to impose increased staffing requirements through the survey process. Ms. DeParle said the Aamorphous@ staffing standard makes it difficult for surveyors to cite staffing during the survey process, although surveyors sometimes do cite staffing. She will consult with HCFA=s General Counsel about the agency=s authority to address staffing in rules and report back to the Committee in writing.

Two of the primary researchers on the study also testified. Andrew Kramer used Medicaid cost reports to determine the threshold levels of nursing care below which residents are at substantial risk of harm. He found that 54% of facilities fall below these levels. Dr. Kramer stressed the importance of using case mix adjustments for staffing levels.

John Schnelle= task was determining the resources needed to provide good care. Using simulation models and highly conservative estimates, Dr. Schnelle reported that facilities would need to provide at least 2.9 CNA hours per resident per day, a standard not met by 92% of facilities nationwide.

Senator Grassley=s opening statement and the statements of the three witnesses are available at: www.senate.gov/comm/aging/general/hr55.htm.

The final HCFA report is available at http://www.hcfa.gov/medicaid/reports.htm. The Center for Medicare Advocacy prepared a statement that focused on the increased Medicare and Medicaid reimbursement, which more than doubled between 1990 and 1998 from $24.8 billion to $51.0 billion, the increased acuity of residents between 1991 and 1998, and the largely unchanged staffing levels between 1991 and 1998. The statement, which also criticized legislative proposals to create a new category of Asingle task workers,@ is available on the webpage. A copy of the statement, with its 24 pages of attachments [the statistical information cited in the statement], is available from Davie Ryan in the Washington, DC office.

For further information, contact Toby Edelman in the Washington, DC office.