Understaffed and Untrained Nursing Homes Costing Billions

A new report recently released shows that the Center for Medicare and Medicaid Services could save billions of dollars by making substantive changes to the way care is managed, delivered and paid for at skilled nursing and other long-term-care facilities. The report showed that the program could save roughly $2.1 billion if hospitalization rates among long-term-care residents were reduced by 25%.

Donald Berwick, the CMS Administrator, offered opening remarks at the briefing and outlined what he called the CMS’ “triple aim”. Under his guidance, the “triple aim” mentioned includes: better care, reducing the need for care through prevention and lower costs, which all relate to the problems and potential solutions in long-term care. Berwick also said that 9.2 million people are covered by both Medicare and Medicaid, two programs that pour money into long-term care. “We’re going to get this answer right,” he said.

Berwick stated to do so the agency will have to address a host of issues that both the reports and experts have said are driving Medicare expenditures for post-acute care, such as inadequate staffing, which includes the level of skill and training among skilled-nurses and caregivers.

Tony Edelman a senior policy attorney with the Center for Medicare Advocacy in Washington stated “We spend a lot of money trying to fix things that went wrong. With proper care, probably would not have gone wrong.” Elderman went on to state “A lack of adequate staffing, there is a great need for clinical providers in this segment, including registered nurses, licensed practical nurses, licensed vocational nurses and certified nursing aides.

But citing a lack of staff might be oversimplifying the problem, said Cheryl Phillips, a physician who is chief medical officer of On Lock, which serves nursing home-eligible seniors. “The challenge is not the right amount of staff, but my issue is the training and skill set of staff,” she added. “Part of the reason facilities send them out of the nursing homes and to hospitals are staffing.”

The Kaiser Family Foundation after conducting 43 interviews with family members and clinical providers at facilities in St. Louis, Miami, Philadelphia and Phoenix, found 10 factors that contribute to hospitalizations. Topping the list was limited on-site capacity at the facility to deal with medical issues.

“Physicians and nurses say that long-term care facility staff often lack the skills and training needed to deal with medical issues, particularly those that are unanticipated and more acute in nature,” the report said, adding that this results from a host of factors, including inexperienced and unseasoned staff – partly as a result of high staff turnover rates – a lack of training and no clear policy on how to deal with certain medical situation, including when to hospitalize a resident; insufficient nurse-to-resident ratios that resulted in over-extended nurses and licensing limitations that do not allow certain medical procedures and tests to be done on-site.

Larry Minnix, president and CEO of the American Association of Homes and Services for Aging stated “We need to start with what is a fundamental level of staffing needed to take care of certain types of patients,” he went on to state ” we need to pay for training, livable wages and benefits for supervisors.” He added “We do know part of it is we need to manage better and part of it is we need to get paid for what we’re doing. But the direct caregiver is as important to a nursing home resident as a heart surgeon is to someone who needs multiple bypasses.”

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