As part of the larger health care reform in our country, President Obama signed into law on March 23, 2010 the Patient Protection and Affordable Care Act (PPACA) which contains provisions for Nursing Home Transparency and Improvement. In a series of posts, I will discuss some of the provisions which affect nursing home care.
This is part 3 in a 5 part series
Part 3 - Staffing
In California, nursing homes are required to provide a minimum of 3.2 Nursing Hours Per Patient Per Day (NHPPD). And nursing home operators are constantly making these calculations. By taking the total hours worked by direct caregivers (RNs, LVNs, CNAs providing hands on care) for a 24 hour period and dividing by the number of residents in the nursing home for that same 24 hour period (referred to as the census), the NHPPD can be calculated. However, these figures are not publicly available.
California nursing homes are required to post in a public place in each facility a similar calculation which is comprised of the number of direct care staff working each shift multiplied by 8 hours (on the assumption each person works an 8 hour shift) and divided by the census. This gives an approximation of the NHPPD, but does not take into account caregivers who work less than (or more than) the 8 hour shift, caregivers who call in sick, RNs who are not providing direct care but rather performing administrative functions, and it is often filled out by rote based upon a monthly or daily schedule. In short, it is not a reliable indicator of staffing. Further, nursing homes don't often keep these records over time so if litigation ensues and a request is made for staffing information, said request is often responded to by saying the facility does not routinely keep that type of information.
So, what does the Nursing Home Transparency and Improvement provision require as it relates to staffing? Nursing homes must submit direct care staffing information to HHS based on payroll data in a uniform format. The information must specify the "category of work" such as whether the employee worked as an RN, LVN, CNA, therapist, or other medical personnel. The provisions also require submission of resident census and information relating to employee turnover and tenure.
If this type of information truly becomes available, it would indeed establish the kind of transparency which leads to consumer protection and has the potential to effect wide spread change. Presently, the only way to know for certain whether a nursing home is meeting the legally mandated minimum standard for nursing hours in California is to sue the nursing home, request payroll and census data, obtain information to discern for each time card whether the person is a direct caregiver (i.e. typically the maintenance and housekeeping and administrative staff payroll records are lumped in with caregiver payroll records) and finally obtain census information. Only after all that data is provided (which information the nursing home operators rarely hand over without a fight), can the direct staffing ratios be calculated, day by day, case by case. It is a laborious and taxing effort. This information, publicly available, would allow these calculations to be made without filing a lawsuit and with much greater ease. If the nursing home operators have to publicly report this data, rather than simply track it internally, they are going to be more likely to be sure the reported data is accurate and meets mandatory minimums.
Part 4 - coming soon.
