Long-term care

Study: High staff turnover at U.S. nursing homes poses risks for resident care

Extraordinarily high turnover among staffs at nursing homes likely contributed to the high number of deaths at the facilities during the COVID-19 pandemic, the authors of a new study suggested (Source: “High Staff Turnover at U.S. Nursing Homes Poses Risks for Residents’ Care,” New York Times, March 1).

The study, which was published Monday in Health Affairs, represents a comprehensive look at the turnover rates in 15,645 nursing homes across the country, accounting for nearly all of the facilities certified by the federal government. The researchers found the average annual rate was 128 percent, with some facilities experiencing turnover that exceeded 300 percent.

Inadequate staffing — and low pay — has long plagued nursing homes and quality-of-care for the more than one million residents who live in these facilities. But the pandemic has exposed these issues even more sharply, with investigations underway into some states’ oversight of the facilities as COVID cases spiraled unchecked and deaths skyrocketed.


1 in 3 Ohio nursing homes is facing staffing shortage, AARP dashboard reports

Over one-third of Ohio nursing homes and long-term care facilities faced a shortage of direct care workers in January, according to new data released this week (Source: “Staff shortages plague 1 in 3 Ohio nursing homes; nearly 1 in 4 in Kentucky struggle too,” Cincinnati Enquirer, Feb. 15).

The data is part of the AARP COVID-19 Dashboard, which uses information reported each week by nursing homes to the Centers for Disease Control and Prevention and released by the Centers for Medicare & Medicaid Services.

Long-term care facilities have made up almost half of Ohio’s COVID-19 deaths, despite combined resident and staff cases comprising only 8% of the state's total cases. 

And the solutions available to nursing homes to curb these shortages, such as bringing in temporary workers or extending hours of current staff, could potentially spread COVID-19 to both residents and staff, one expert said.


Indoor nursing home visits to resume Oct. 12, DeWine announces

Indoor visitations at nursing homes and long-term care facilities will be permitted to restart across the state as soon as Oct. 12, Gov. Mike DeWine announced Thursday (Source: “Indoor nursing home visits can restart on Oct. 12, DeWine says,” Crains Cleveland Business, Sept. 25).

Outdoor visitation went into effect, after months of a complete shutdown, for assisted living in early June and for nursing homes in July. "We know it is going to get cold and that outdoor visitation will no longer work," DeWine said.

Ohio Department of Aging director Ursel McElroy said facilities will be required to have access to adequate testing, staffing and personal protection equipment before allowing indoor visitation. All facilities, she said, must report to the state coronavirus data that will be published on a dashboard. According to the new guidelines, visitors will be screened and required to wear a mask during the visit. Only two visitors are permitted at one time, with visits limited to 30 minutes.


Medicare experimenting with paying for more in-home care

Starting next year, Medicare will begin piloting a program that allows in-home support for seniors in many states through private Medicare Advantage insurance plans (Source: “Medicare expands access to in-home support for seniors,” Associated Press via ABC News, Nov. 9, 2018).

The newly covered services are similar to what people might need if they required long-term care, said Howard Gleckman, a senior researcher at the nonpartisan Urban Institute think tank.

"It begins to break down the wall between long-term care and Medicare, which, with very few exceptions, has never paid for long-term care," Gleckman said.

The new services will be offered by some Medicare Advantage plans in more than 20 states next year, and that's expected to grow over time.


Report: Despite federal requirement, 1 in 4 nursing home abuse cases unreported

More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients apparently went unreported to police, says a government audit that faults Medicare for failing to enforce a federal law requiring immediate notification  (Source: “Abuse in nursing homes unreported despite law,” Columbus Dispatch, Aug. 28, 2017).

The Health and Human Services inspector general’s office was issuing an “early alert” Monday on its findings from a large sampling of cases in 33 states. Investigators say Medicare needs to take corrective action right away.

Using investigative data analysis techniques, auditors from the inspector general’s office identified 134 cases in which hospital emergency room records indicated possible sexual or physical abuse, or neglect, of nursing home residents. The incidents spanned a two-year period from 2015-2016.

In 38 of the total cases (28 percent), investigators could find no evidence in hospital records that the incident had been reported to local law enforcement, despite a federal law requiring prompt reporting by nursing homes, as well as similar state and local requirements. The federal statute has been on the books more than five years, but investigators found that Medicare has not enforced its requirement to report incidents to police and other agencies, or risk fines of up to $300,000.


VA to prioritize rural areas for nursing home funding

Veterans Affairs Secretary David Shulkin said Monday during a visit to Montana that his agency will propose changes to make it easier for rural areas to receive funding to build nursing homes for veterans (Source: “VA seeks to funnel more nursing home money to rural areas,” Washington Post, Aug. 21, 2017).

Rural areas are often bypassed under the agency’s existing guidelines for awarding grants for veterans’ homes, Shulkin told reporters.

The VA now sets its priority list by looking at veteran demographics and the need for beds, making it difficult for some rural areas to compete, VA officials said. The agency plans to propose regulation changes by year’s end to ensure some of the money goes specifically to rural areas. Whatever proposal emerges must go through a public comment period, so it’s unclear when any changes may take effect.


Kasich continues push for long-term care payment reform

State officials yesterday released a database of Ohio’s 929 long-term care facilities as part of Gov. Kasich’s push to pay nursing homes based on quality standards. (Source: “State releases nursing home database in push for tighter regs,” Columbus Dispatch, May 12, 2017)

Kasich’s proposal was pulled out of the two-year budget last week by the Ohio House, which pushed managed-care reforms back to 2021. But the governor hopes to persuade the Senate to reinsert his proposal.

Kasich advocates for a managed-care system in which nursing homes would be paid more if they provide higher-quality service, while homes providing lower-quality service would be paid less. The administration says that some nursing homes “underperform on critical quality measures in part because the current reimbursement system does not financially reward high quality or quality improvement.”

A separate report released this week by the Scripps Gerontology Center at Miami University showed that Ohio ranked below the national average on all 10 quality measures used to evaluate nursing homes by the federal Centers for Medicaid and Medicare Services.


Feds extend deadline for Medicaid standards of care

The Trump administration has given states three extra years to carry out plans for helping elderly and disabled people receive Medicaid services without being forced to go into nursing homes (Source: “CMS Gives States Until 2022 To Meet Medicaid Standards Of Care,” Kaiser Health News, May 11, 2017).

Federal standards requiring states find ways of delivering care to Medicaid enrollees in home and community-based settings will take effect in 2022 instead of 2019, the Centers for Medicare & Medicaid Services announced this week.

The standards were set by an Obama administration rule adopted in 2014 that governs where more than 3 million Medicaid enrollees get care.


Feds roll out new ‘person-centered’ nursing home rules

About 1.4 million residents of nursing homes across the country now can be more involved in their care under the most wide-ranging revision of federal rules for such facilities in 25 years (Source: “New Nursing Home Rules Offer Residents More Control Of Their Care,” Kaiser Health News, Jan. 4, 2017).

The changes reflect a shift toward more “person-centered care,” including requirements for speedy care plans, more flexibility and variety in meals and snacks, greater review of a person’s drug regimen, better security, improved grievance procedures and scrutiny of involuntary discharges.

The federal Medicare and Medicaid programs pay for most of the nation’s nursing home care — roughly $75 billion in 2014 — and in return, facilities must comply with government rules. The new regulations, proposed late last year by Health and Human Services Secretary Sylvia Mathews Burwell, take effect in three phases. The first kicked in in November.


CMS announces sweeping update of federal nursing home rules

The federal government has moved to ban nursing homes from making new patients sign agreements requiring them to take disputes — even claims of abuse, sexual harassment or wrongful death — to a professional arbitrator instead of court (Source: “Advocates for seniors hail feds' new nursing-home rules,” Columbus Dispatch, Oct. 7, 2016).

In its first sweeping update since 1991, the Centers for Medicare and Medicaid Services also is making it more difficult for facilities to involuntarily discharge or transfer residents. It also is expanding training requirements for employees. And it is adding a provision that an initial care plan has to be developed within 48 hours of a resident being admitted.

The final rule is targeted at reducing unnecessary hospital readmissions and infections, improving quality of care and enhancing the safety of the nation’s 1.5 million nursing home residents, CMS said. The provisions, which are more than 700 pages long, will be phased in over three years. The first phase takes effect in just over seven weeks.