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Charlene Harrington, professor emerita at the University of California San Francisco, and Center for Medicare Advocacy Senior Policy Attorney Toby S. Edelman have written an analysis of the class action lawsuit against twelve Golden Living nursing facilities in Arkansas for insufficient nurse staffing. The case was settled for $72 million in 2017.[1]  In “Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain,”[2] Harrington and Edelman describe the extensive evidence on inadequate staffing levels at the facilities that was developed during the litigation.  This evidence included deposition testimony of seven directors of nursing that their facilities were understaffed and that management was informed but unresponsive; data documenting inflated staffing levels reported to the state; grievances from residents and their families about lack of staff and basic care; survey deficiencies reflecting inadequate staffing; and residents’ medical records documenting serious quality of care problems. 

The settlement also underscores the potential significance of language added to the federal Requirements of Participation for nursing facilities in 2016[3] that requires that facilities determine their staffing needs[4] during the facility assessment process.[5]  The new regulatory language requires facilities to rely on the professional expertise of their nurses in determining the care needs of their residents and how those needs will be met.

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[1] A Center Alert in January 2018 discussed the settlement of the lawsuit.  CMA, “Lawsuit Challenging Chronic SNF Understaffing Settled for $72 Million,” (Jan. 2018),
[2] Inquiry: The Journal of Health Care Organization, Provision, and Financing, Vol. 55: 1-12 (2018),
[3] 81 Fed. Reg. 68,688 (Oct. 4, 2016),
[4] 42 C.F.R. §483.35.
[5] 42 C.F.R. §483.70(e).

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