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. 2018 Jan-Dec:55:46958018788686.
doi: 10.1177/0046958018788686.

Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain

Charlene Harrington  1 , Toby S Edelman  2
Affiliations

Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain

Charlene Harrington et al. Inquiry. 2018 Jan-Dec.

Abstract

Large for-profit nursing home chains in the United States have generally reported low nurse staffing levels. This historical case study examined a class action litigation case regarding staffing levels, resident rights, and quality outcomes in 12 Arkansas nursing homes owned by a large for-profit chain. The questions were as follows: (1) How did the residents' care needs compare with actual nurse staffing levels? (2) How did the staffing levels compare with federal and state nurse staffing requirements and professional staffing standards? (3) Did the facilities comply with state and federal residents' rights and quality of care requirements? The findings showed staffing levels marginally above state minimum standards, staffing shortages that violated state standards, staffing levels not adjusted for resident acuity, and shortages that resulted in omitted care. Staffing levels were lower than needed according to nursing directors, lower than average facilities in the state, and lower than professional standards. The findings showed many resident grievances regarding basic care and residents' rights, clinical measures of poor quality, and state deficiencies. A large settlement was agreed on to compensate the residents. The case shows that chain's management, as well as the regulatory system, failed to ensure adequate staffing levels that took into account regulatory requirements and professional standards and resulted in violations of residents' rights, health, safety, and well-being.

Keywords: litigation; nurse staffing; nursing home chains; quality of care; regulation; resident rights.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The lead author on the paper was a paid consultant to the plaintiffs on the case. The second author had no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Discrete event simulation (DES) test results for Golden Living—Arkadelphia, December 1, 2006, to June 30, 2009.
See this image and copyright information in PMC

References

    1. US General Accounting Office. Nursing Home Quality: Prevalence of Serious Problems, While Declining, Reinforces Importance of Enhanced Oversight—Report to Congressional Requesters GAO-03-561. Washington, DC: General Accounting Office; 2003.
    1. US Government Accountability Office. Nursing Homes: Addressing the Factors Underlying Understatement of Serious Care Problems Requires Sustained CMS and State Commitment. GAO-10-70. Washington, DC: US Government Accountability Office; 2009.
    1. US Office of the Inspector General. Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries. OEI-06-11-00370. Washington, DC: US Office of the Inspector General; 2014.
    1. US Office of the Inspector General. Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring. OEI-06-11-00040. Washington, DC: US Office of the Inspector General; 2013.
    1. Harrington C, Carrillo H, Garfield R. Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 2009 Through 2015. Washington, DC: Kaiser Family Foundation; 2016.

MeSH terms