HEALTH CARE FINANCING BRIEF - Protecting Current & Future Nursing Home Residents and Their Families - Challenging Conventional Wisdom on the Cost of Mandating Minimum Safe Staffing

Sep 5, 2026

Uploaded by Maeve

Health care financing brief argues that inadequate nursing home staffing is the core cause of persistent poor quality, harm, and financial waste despite heavy public investment. It highlights how skilled nursing facilities absorb a large share of Medicaid spending and notes that many homes have repeated poor-care citations with limited progress. The brief calls on government leaders to require safe staffing levels, pairing resident safety and dignity with fiscal efficiency. It also links costs to Medicaid fraud and other financial inefficiencies and argues that increasing staffing can reveal savings while improving continence care.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Medicaid Fraud and Other Opportunities to Control Costs

Increase Staff to Decrease Costs

HEALTH CARE FINANCING BRIEF PROTECTING CURRENT & FUTURE NURSING HOME RESIDENTS AND THEIR FAMILIES: CHALLENGING CONVENTIONAL WISDOM ON THE COST OF MANDATING MINIMUM SAFE STAFFING INTRODUCTION: Concerns about growing healthcare expenditures, the rapidly aging baby boomer generation and the persistence of serious, widespread problems for nursing home residents all point to the urgent need to address problems in the nursing home system. Nursing home advocates know there is only one solution that can improve quality of care and significantly reduce unnecessary expenditures at the same time—invest in the workforce. At congressional hearings to mark the 20th anniversary of passage of the Nursing Home Reform Law (OBRA’87 ) , Dr. Charlene Harrington , one of the leading researchers in this field , gave a simple explanation for the persistent poor quality of nursing home care: “the basic problem is that we have inadequate staffing levels.” 1 As Dr. Harrington’s and others’ works have repeatedly shown , staffing levels are key to nursing home quality. Yet while we entrust nursing homes with our most frail loved ones, and provide them with significant public money to give good care , we do not require that they maintain the staffing levels needed to provide adequate care and prevent harm from neglect or abuse. Skilled nursing facilities account for 15% of all Medicaid expenditures nationally, costing $5 billion more than regular payments for inpatient hospital expenditures.2 Yet, as Senator Herb Kohl, Chairman of the Senate Special Committee on Aging stated , “in 2006 , nearly one in five nursing homes nationwide were cited for poor care that causes actual harm to residents. Among a group of facilities studied in 1998 and 1999 that provided poor care , the agency found that nearly half have made no progress between that time and now.” As Senator Kohl noted, “this is unacceptable.” How can our nursing homes have such persistent, significant problems when so much of our money is invested in them to provide good care? Clearly, action is needed to bridge the gap between the level of care we are paying for and that which we are getting. “the basic problem is that we have inadequate staffing levels.” Because so many nursing homes will not make the investment in the nursing homeworkforce on their own, it is crucial that our government leaders require that nursing homes have safe staffing levels. This brief describes how increasing nursing home staffing levels can not only lead to improved quality of life and quality of care , it can also result in cost savings and increased financial efficiency. 1 Harrington C.“Efforts to Improve Nursing Homes” Testimony, Senate Special Committee on Aging. Washington DC. 2007 May 2. LexisNexis. 2 Medicaid Expenditures for Selected Categories of Service by Category of Eligibility – January 2007 – March 2007. New York State Department of Health. 2007 Jun. Available at: [http://www.health.state.ny.us/nysdoh/medstat/quarterly/aid/2007/q1/expenditures.htm](http://www.health.state.ny.us/nysdoh/medstat/quarterly/aid/2007/q1/expenditures.htm) Protecting Future & Current Nursing Home Residents and Families: Challenging Conventional Wisdom on the Cost ofMandating Minimum Safe Staffing MEDICAID FRAUD AND OTHER OPPORTUNITIES TO CONTROL COSTS WITHOUT SACRIFICING RESIDENT SAFETY & DIGNITY: In order to address nursing home quality and the cost of adequate care , we must first address persistent Medicaid fraud and other financial inefficiencies. Medicaid Fraud Medicaid fraud is not limited to fraudulent reporting. Medicaid fraud also occurs when providers, who take in tax payer dollars with the promise of providing good care and quality of life, fail to fulfill that promise. Hiring enough staff to care for the vulnerable residents is a key component of fulfilling this promise , yet it is all but completely overlooked in our oversight and accountability mechanisms. We would not permit nursing homes to

FAQs

Why does the brief say poor nursing home quality persists?

It points to inadequate staffing levels as the basic problem driving persistent poor quality and resident harm.

How does the brief connect Medicaid fraud and oversight to nursing home costs?

It argues that fraud includes failing to fulfill the promise of good care, especially by not hiring enough staff, while reimbursement continues without meaningful enforcement.

What does the brief claim about increasing staffing levels and financial outcomes?

It states that raising staffing can improve care quality and can also uncover cost savings, including through better continence care that reduces related expenses.

Sep 5, 2026

Uploaded by Maeve