Chains and Staffing

A recent study conducted by Matthew P. Maughan examined more than 9,000 US nursing homes across 610 different chains. Maughan told McKnight’s Long-Term Care News:

“Large chains benefit in terms of administrative efficiency, but staffing is one of those inputs to the process that does not ‘scale’ well; larger employers can get by on less administrative cost or overhead per resident, but direct care staffing is difficult to make more efficient, as various studies have shown. Less staffing equates to worse care.”

The study found that larger chains had more prevalent staffing challenges, including staffing instability and few hours of direct patient care.

The Department of Population Health Science at Weill Cornell Medicine segments nursing home chains into five different quintiles based on staffing levels. Facilities of higher quintiles provided fewer total nurse staffing hours per resident per day. Data for quintile one was not listed, but quintile two averaged -0.40 hours less per resident per day, quintile three had 0.45 hours less, quintile four had -0.50 hours less, and quintile five had -0.69 hours less, the largest.

Researchers say that the study’s staffing data can be particularly interesting for regulators in regard to the Centers for Medicare & Medicaid Services’ first nursing home minimum staffing rule in April. This rule mandates 0.5 hours of daily direct care by registered nurses as part of an overall equation involving other nurse positions. Chains in quintile one were the only ones that met the minimum requirement for RNs at 0.72 hours.

In comparison, RNs working at quintile five chains averaged only 0.41 hours. Experts say large chains with ample access to resources should use them to help their facilities comply. Maughan said, “Ownership groups of all types should find ways to leverage their size for efficiencies while also finding barriers to providing high-quality staffing, highlight those barriers to regulators and policymakers, and make sure to maintain high staffing standards. If particular issues make it especially difficult to meet standards in given nursing homes, regulators would love to hear them.”