• Fewer nurses at for-profit nursing homes leads to poorer care Wednesday, November 30, 2011

    The quest for profit in the nursing home industry is leading to lower quality care for seniors as a result of dangerously-, and sometimes illegally-, low staffing levels.

    UCSF professor emerita Charlene Harrington

    “Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit chains,” according to University of California, San Francisco professor emerita Charlene Harrington, who led a study on the issue that has been published online in Health Services Research. Harrington also said in a university news release, “The top 10 chains have a strategy of keeping labor costs low to increase profits. They are not making quality a priority.”

    The study, conducted by Harrington, two colleagues at UCSF and a student at the UC Irvine School of Law, looked at the ten largest for-profit nursing home chains in the country. Together, the chains operate about 2,000 nursing homes and house approximately one of every eight nursing home beds in the nation.

    Among the chains is Skilled Healthcare, LLC, which was the target of a lawsuit stemming from the understaffing of 22 of its facilities in California. After a Humboldt County jury returned a $677 million verdict against the chain, a settlement was negotiated that included an injunction requiring Skilled to verify it is meeting California’s legally-mandated minimum staffing levels. The foreperson of the jury said documents from Skilled Healthcare that were submitted into evidence showed company officials treated the state mandate of 3.2 hours of nursing care per patient per day “as a goal instead of a minimum.”

    “The evidence showed that the lower they got below 3.2, the more they were putting people at risk,” said foreperson Bob Hart. “Maybe residents didn’t get a shower, okay…but maybe they didn’t get food, or maybe they didn’t get turned, things that could lead to bad things happening.”

    The UCSF study verified the relationship between staffing levels and patient safety. From the university’s news release:

    From 2003 to 2008…[the chains'] total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

    The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41  percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.

    Since the data for this study were compiled, the verdict in the Skilled Healthcare case has led nursing home operators across the country to reevaluate their staffing levels so as to avoid penalties like the one assessed to Skilled, which will amount to more than $60 million including the cost of monitoring its staffing. With state regulators lacking the resources to enforce staffing laws, the civil justice system plays a crucial role in ensuring safety for vulnerable senior citizens.

    –J.G. Preston

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