Nursing Homes Pocket the Money

Nursing homes will argue that the RUG scores are for Medicare residents only, and that most of their residents are paid by Medicaid. Since the Medicaid reimbursement is a lot lower, the number of staff should be lower. However, this ignores what the STRIVE study showed. The STRIVE study, and the other three older time studies, showed how long it took staff to perform certain activities. It doesn’t matter how the nursing staff was getting paid, this wasn’t part of this calculation. It takes just as long to dress a resident of a particular RUG score regardless if they are a Medicare resident, Medicaid resident or even private pay. The STRIVE study actually included all residents regardless of pay source. Even if the facility was paid more, there is no evidence they would hire more staff. Just look at this title of a November 2002 GAO report to Congress: “SKILLED NURSING FACILITIES- Available Data Show Average Nursing Staff Time Changed Little after Medicare Increase.”[i] The facilities try to have their cake and eat it too.

The nursing homes may argue that the Medicaid reimbursement rates don’t allow them to provide the levels of staffing to meet the needs of residents. While the ability to pay and the profitability of nursing homes is too large of a topic for this article, it really doesn’t matter for our initial analysis- how many staff are needed to provide reasonable care. Again, according to North Carolina code set out above, subsection (b) states, “the facility shall provide other nursing personnel sufficient to ensure that activities of daily living, personal care, delegated nursing tasks and other health care needs, as identified in each patient’s plan of care, are met.” While this time studies may not be definitive as to how many staff hours per patient day are reasonable, it certainly is strong evidence and there are no studies to the contrary.

Even if we buy the nursing home arguments that the RUG scores should only apply to Medicare residents, those residents aren’t receiving sufficient care either. Around ten to fourteen percent of all residents in skilled facilities are Medicare eligible. The facilities specifically target as many Medicare eligible residents as they can admit, because their reimbursement is so high. Since the Brian Center only provided 2.8 nhppd, did they instruct staff to make sure and spend extra time with the Medicare residents? They would need to almost double the amount of staff to meet the Medicare residents’ needs. If you depose CNAs and nursing staff, they will all testify that this didn’t occur. Why would Medicare continue to pay based on these high RUG payments, when the data shows that the corresponding services weren’t provided? Medicare should pay for the actual staff and actual care provided and not just on the acuity level of residents. To do otherwise is to simply line the pockets of the nursing home chains. If you suspect such nursing home abuse or neglect, call the lawyers at Roane Law. We will talk to you for free and at least help you to get some answers.

[i] GAO-03-176