Facility information on staffing can be found through a variety of sources. The primary pre-suit source of information is the facility licensing file. Of course, you should never file suit without this file as it should help shed light on the true operators and owners of the facility. The licensing file will contain some staffing information such as the Form CMS-671. Form 671 is filled out by the facility and contains a breakdown of the number of hours for each staff member in the facility. The annual recertification survey will compile staffing only for the two-week period prior to the survey.
Don’t simply accept the Form 671 numbers. In many cases, staff testify that they knew when N.C. Department of Health Service Regulation (DHSR, DHHS, DFS or simply “the state”) was coming. Maybe, the facility is just guessing and trying to “time” the survey as all facilities must have a survey no more than fifteen months apart with the state average a maximum of twelve months.[i] Annual surveys may fall in regular patterns and the facilities start to clean up and add staff when they feel that a survey is imminent. Also, some nurses have testified that they stay in communication with other facilities. The surveyors may always inspect facilities in some sort of generally predictable order, and one administrator calls another and says “you are next.” Therefore, the facilities narrow down the possible survey window. Finally, some staff have testified under oath that the facility is actually told when the state is coming. Staff numbers may temporarily increase, which is consistent with the disparity of what is reported during the survey with the Medicaid Cost Reports. During this two week survey window, staffing reports a 38% higher mean level of RNs as compared with the cost reports.[ii] Of course, all surveys are required by federal law to be unannounced, and the purpose is “it increases the probability that the surveys will observe conditions and care practices that are typically present.”[iii] In practice, this doesn’t always happen.
Aside from the Form 671 staffing, look at the Form 672 Census/Acuity, which should also be in the licensing file. The Census lists how many residents are independent, require assistance or are totally dependent. The Census will list the numbers of residents with catheters, bedfast, contractures, behavioral problems, etc. All of this information provides some details regarding the overall acuity levels of the residents. Of course, with increased acuity, facilities need increased staffing levels. Without the increased staffing, the overall acuity can continue to increase. So, look at the number of contractures, incontinent residents, the overuse of psychotropic drugs as all of these may indicate understaffing. The section for Skin Integrity will show how many have sores and how many residents had sores on admission. Do the math and subtract these numbers, and you can see how many residents developed sores while admitted. If this a high number develop sores, it could be evidence of failure to turn and position and under staffing. If you do find evidence of such nursing home abuse or neglect, call the attorneys at Roane Law.
The information contained on both Form 671 and 672 are forwarded to CMS and are reported on the CMS website at www.medicare.gov/nhcompare/ You can check this website search for particular facilities, or just search all facilities in that county so you can compare staffing and deficiencies among facilities. The website doesn’t have the actual forms from the facilities. However, the staffing values are compiled from these forms. The Medicaid and Medicare Cost Report data is submitted by the facilities to the government for reimbursement purposes. Staffing information can be found in these reports, and these reports contain much more detail on costs and other financial information.
[i] CMS- State Operations Manual Chapter 7 Section 7205
[ii]“Comparing Staffing Levels in the Online Survey Certification and Reporting (OSCAR) System with the Medicaid Cost Report Data: Are Differences Systematic?” Kash, Hawes and Phillips. The Gerontologist. Vol. 47 Issue 4. (2007)
[iii] CMS- State Operations Manual Chapter 7 Section 7207.2 “All Surveys Must Be Unannounced”, and penalties at Section 7207.4