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Would higher Medicaid reimbursement boost nursing home staffing?

On Behalf of | Jan 26, 2018 | Nursing Home Abuse

Many nursing homes are critically understaffed or are forced to hire workers with sketchy backgrounds. This staffing deficit in turn leads to serious harm to thousands of patients from negligence, neglect and abuse.

A government report concludes that more than 90 percent of U.S. nursing homes lack the minimum level of staff. But the report suggests that raising Medicaid reimbursement rates translates to more hiring of licensed staff and improved quality of care.

The need for quality nursing staff will only increase

The aging population is already straining the capacity of our nursing home system. The cost of care reached $163 billion in 2016, according to the federal Center for Medicare and Medical Services, and 91 percent of facilities were short-staffed. Elder care is funded by a combination of private payments, state Medicaid reimbursements, state taxes on providers, and federal Medicare subsidies.

Research commissioned by the CMS shows that competition in the nursing home market can boost quality of care. But the study showed that a modest increase in Medicaid reimbursements pays even greater dividends. According to the model, a 10 percent increase in Medicaid rates leads to a 9 percent increase in the number of skilled nurses per resident. This has a tangible effect on quality of care – an estimated 10 additional minutes of care per resident per day. Repositioning a bedridden patient. Assisting them in the bathroom. Engaging them in activities or exercise. Monitoring their nutrition and vital signs. And so on.

New Jersey has increased Medicaid reimbursements, but still has a cost gap

New Jersey was among 40 states that increased Medicaid reimbursement rates in 2014 and 2015. (By contrast, New York and Connecticut did not.) But the cost of long term nursing care is higher than average in New Jersey, and there is still an estimated shortfall of $35 per patient per day, based on recommended staffing levels. (By comparison, the nationwide average is a deficit of $22 per patient per day.) While some of that shortfall is covered by Medicare and by a tax imposed on providers, there is still a gap.

When nursing homes lack funding to attract and hire qualified staff, they have two choices: (a) make do with fewer licensed caregivers or (b) hire people who can’t get jobs elsewhere because of convictions, terminations and other black marks. It is not entirely shocking, then, when we read about nursing home abuse and neglect. Residents languishing for lack of care, suffering from bed sores or other medical complications. Or residents subjected to physical, sexual and emotional abuse by uncaring, unqualified and underpaid staffers.

Nursing homes are accountable for providing care

According to the CMS study, raising Medicaid reimbursements not only improves the quality of patient care, it also allows facilities to charge lower rates for residents who have private long term care insurance. Unfortunately, the cost barrier is a deciding factor when families choose a nursing home. Yet even high-priced nursing homes are routinely cited for understaffing and substandard care.

Nurse home facilities can be held liable for negligent hiring or understaffing when it directly relates to a patient’s harm or untimely death. In that event, talk to a personal injury lawyer who has experience with nursing home litigation.