A new study by Public Integrity finds widespread discrepancies in actual staffing levels and those reported to the state and federal government. You can read the full article here.
I often find significant issues with the administration, management and operating of nursing homes in the cases we prosecute – things that families couldn’t possibly know when they select a facility. The Public Integrity staffing study illustrates this problem because it points out that even though a facility may have a great rating on staffing from the government that you can see on-line, that rating may be based on bad data.
To avoid this problem, I always recommend asking the right questions when admitting a resident. When it comes to staffing, I recommend specifically asking about ratios of CNAs to resident – not nurses, as these are not the workers that do the majority of the hands-on care. The lower the ratio, the better. A day shift ratio of 1:10 could be a real problem, and 1:6 or 1:7 is far better. You can imagine what it’s like to care for 10 dependent elderly people, many with dementia and Alzheimer’s, at one time.
I also recommend asking if there is a policy of exceeding the state minimum requirements. New Jersey has minimum nurse hour requirements. Many administrators say in their depositions that “adequate staffing” means simply meeting the state minimum hour requirements. Unfortunately, the state minimum hour requirements just track “bodies in the building.” They don’t take into account how good the aides are, how morale is, how much the aides like the work, how hard they work, and how experienced they are.
I also recommend asking about weekend and holiday hours, which some families report are much lighter than they should be.
A family should ask how a facility handles a CNA shortage. I would ask about how many agency or contract workers the facility uses. These are people who come in from an agency when there are shortages. Contract or agency personnel are generally considered sub-standard because they don’t know the residents or the facility and just come in and get periodic assignments. Another way some facilities fill open positions is simply making aides work double shifts – a daunting task which invites disaster.
Making sure there are adequate staffing is paramount to good care. Asking the right questions is key to making sure facilities have enough people to do the required work.