A staggering new study reveals that nearly 75% of nursing homes consistently fall short of meeting expected registered nurse staffing levels.

A recent study has found that approximately 75% of nursing homes in the United States do not meet federal staffing expectations for registered nurses (RNs). The research, conducted by Harvard and Vanderbilt medical schools, analyzed payroll data from over 15,000 nursing homes across the country. The findings revealed that RNs are often absent from facilities on weekends, with 91% of facilities meeting expected staffing levels less than 60% of the time.

The study also found a significant discrepancy between self-reported staffing levels and actual staffing levels. Researchers discovered that 70% of facilities reported higher total direct staffing under the CASPER system compared to the Payroll-Based Journal (PBJ) system, which is now the standard for reporting staffing levels. The discrepancy was most pronounced at for-profit facilities.

The study's findings have broader implications than just staffing levels. David Grabowski, a co-author of the study, noted that many quality measures reported on Nursing Home Compare are self-reported and subject to bias. He suggested that CMS (Centers for Medicare & Medicaid Services) should increase auditing of these measures to improve reporting accuracy.

Industry leaders have responded to the study's findings by highlighting the challenges of recruiting and paying staff in the long-term care sector. Organizations such as LeadingAge and the American Health Care Association (AHCA) argued that judging nursing home quality solely on staffing levels is misguided, citing other important metrics such as care outcomes and patient satisfaction.

The study's authors concluded that CMS should leverage daily payroll data to incorporate staffing variation over time in its calculation of star ratings. They also suggested that surveyors should be aware of whether the staffing level at the time of inspection is typical, rather than relying on self-reported numbers or "staffing up" for inspections.