Compliance Perspective – Understaffing:
The Compliance Officer will review the facility’s policies and procedures with the DON, the QAPI Committee and the Compliance Committee regarding the nursing staff level needed (which may need to exceed state or federal staffing level requirements) to provide the nursing and related services required to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and plans of care. The shift supervisor will be responsible for ensuring that the Actual Staffing Roster is posted daily in the required locations and meets all requirements. The Actual Staffing Roster and Actual Schedule of Staff Working each day must be retained to provide the documentation supporting the facility’s staffing compliance. The staff will receive training regarding developing and implementing an individualized, comprehensive care plan including care plan timing and revision for individual residents. The Compliance Officer will ensure that an audit is developed and implemented to review staffing levels monthly, and the results of this audit will be submitted for review and recommendation to the QAPI Committee.
A lawsuit was recently filed on behalf of a resident at a Northern California 98-bed nursing home, and it alleges that the nursing home’s understaffing is “chronic and intentional” and an “effort to pocket unearned profit.”
This lawsuit filed by a California elder abuse law firm representing residents, workers and their families is among 15 class action lawsuits claiming that the nursing homes deliberately understaffed to save money and increase profits.
Although the lawsuits name multiple defendants, none of them claim any harm to the residents of the facilities. The attorney representing the nu
rsing home in northern California contends that the nursing home is in full compliance regarding staffing laws and the increase in staffing levels that were required as of July 1, 2018. He presented documents to demonstrate that the California DPH reported that the nursing home had “zero days of non-compliance with required staffing levels in 2016.” However, the DPH was not able to authenticate the documents right away.
The attorney representing the 14 other defendants asserted that those facilities “not only maintain the state required 3.2 nursing hours per patient day, they even exceed them.”
Notably, the new minimum number of hours required by the California DPH was increased from 3.2 to 3.5 nursing hours per patient on July 1.
The plaintiffs’ attorney contends that “facilities caring for the sickest patients in need of additional care have a higher staffing minimum than other nursing homes.” He said the key issue in the lawsuit is not “about minimum numeric ratios,” but about “having sufficient staff to meet the significant needs of the actual patients.” He also alleged that documents submitted by the defendants to the CMS demonstrate that those nursing homes had all admitted residents who were so ill and in need of care they required “as much as 4.1 nursing hours per patient day to properly care for them.” He claims that the minimum requirement referenced by the defendants is “irrelevant.”
All 15 facilities have received media attention in the last few years regarding care practices, lawsuits, police investigations and some have even been decertified and stripped of Medicare funding.
The California State Auditor contends that the ineffective oversight by the DPH has allowed a substandard quality of care to continue not only in the 15 nursing homes involved in the lawsuit, but within other California nursing facilities.
