Inadequate staffing is a widespread and persistent problem in nursing homes in Virginia. We have written extensively about how there are no minimum staffing requirements for Virginia nursing homes. Despite the failure to ensure staffing at the state level, the federal Centers for Medicare & Medicaid Services (CMS) asserts “nurse staffing is directly related to the quality of care that residents experience.”
The federal government recently indicated serious concerns about inadequate staffing, particularly on nights and weekends. A November 30th, 2018 letter from CMS warned about inadequate staffing at nursing homes. A New York Times analysis found 11% fewer nurses providing direct care and 8% fewer aids on weekends as opposed to weekdays. Nursing home residents and their families often tell us of the difficulty in getting basic help, such as assistance going to the bathroom, on weekends. The federal government is so concerned about inadequate staffing at nursing homes it recently ordered states to conduct more weekend inspections.
The ability to find out staffing levels at individual nursing homes is critical to ensuring quality care for your loved one. Until recently, it was difficult for family members to determine which facilities staffed appropriately. Now, there are easy-to-use resources available. On December 11, 2018, the Long Term Care Community Coalition, an advocacy group, announced it will publish staffing information for every nursing home in the country. Simply visit their website, www.nursinghome411.org, to download sortable spreadsheets for every state that include:
- The facility’s direct care RN, LPN, and CNA staffing;
- The ratios of care staff to residents;
- Select non-nursing staff hours per day, including administrators, social workers, and activities staff; and
- The extent to which the facility relies on contract staff to provide resident care.
You can download the Virginia data set for the second quarter of 2018 here. Every family member with a relative in a nursing home should review this data to see if the facility they use has been staffing appropriately.
The data are not encouraging. In the second quarter of 2018, Virginia nursing homes averaged 3.5 hours of total direct care per resident per day. A landmark 2001 federal study indicated at least 4.1 hours are needed to meet a typical resident’s needs. Virginia nursing homes also averaged 0.4 hours of RN staff time per resident per day, less than the 0.5 hours averaged nationally and significantly less than the 0.55-0.75 RN hours recommended by the same 2001 study.
 U.S. Centers for Medicare and Medicaid Services. Payroll Based Journal (PBJ) Policy Manual Updates, Notification to States and New Minimum Data Set (MDS) Census Reports, (Nov. 30, 2018), available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO19-02-NH.pdf.
 Jordan Rau. ‘It’s Almost Like a Ghost Town.’ Most Nursing Homes Overstated Staffing for Years. New York Times (July 7, 2018), available at https://www.nytimes.com/2018/07/07/health/nursing-homes-staffing-medicare.html.
 Id. at Payroll Based Journal.
 Available at https://nursinghome411.org/wp-content/uploads/2018/12/VA-Staffing-2018Q2.xlsx.
 U.S. Centers for Medicare and Medicaid Services. Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes: Phase II Final Report. (December 2001). Available at https://phinational.org/wp-content/uploads/legacy/clearinghouse/PhaseIIVolumeIofIII.pdf.