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Supreme Court Decides: Nursing Home Residents/Families Can Sue Public Facilities

This morning, the Supreme Court ruled that residents and their surviving heirs/family members can sue a publicly owned nursing home under the Federal Nursing Home Reform Act. The court upheld a lower court ruling against the Health and Hospital Corporation of Marion County (HHC). This organization operates publicly owned (governmental) SNFs in Indiana. A couple of months ago, I wrote about this case in another post. Readers can access the post here:

HHC had argued that the existing federal Conditions of Participation for SNFs governing Medicare and Medicaid participation was the proper avenue for recourse against care violations or other procedural violations, not civil court.

In this case, a family (Tavelski) sued HHC for mistreatment regarding the use of psychotropic medications and transfers to other facilities without permission/patient (or designated surrogate) consent. HHC alleged that the Tavelski family could not pursue civil action but instead, had to use administrative remedies available to them in the federal and state SNF code.

The fundamental question that was addressed was whether patients/families could pursue civil action via the courts against publicly (county/state) facilities under the Nursing Home Reform Act of 1987 OR, was the sole course of remedies available, only via administrative law (grievance, appeals, etc.) through CMS. The Court found that nothing in the Nursing Home Reform Act precluded a family/patient from accessing the courts for remedies, if applicable.

The decision will have far-reaching implications beyond nursing home residents/families having a right of private legal action. The decision will branch to other matters involved Medicaid access, insurance rights, benefit qualifications, prior authorization, enrollment, etc., including for families and children with respect to Medicaid. Prior law required redress of any issues to be made through the applicable state or federal agency via administrative appeals.

The full Supreme Court decision is available here: Tavelski Decision 6 8 23


June 8, 2023 Posted by | Health Policy and Economics, Policy and Politics - Federal | , , , , , , , , , , , | 2 Comments

Home Health and Assisted Living: Compliance and Litigation Tips to Note

A growth, if you will, opportunity for many Assisted Living facilities is caring for a more clinically complex resident or resident group. The clinical complexity is very much tied to additional medical and physical frailty, necessitating access at times to skilled nursing and therapies. Most Assisted Living facilities, especially those not affiliated with a national or regional organization with infrastructure services such as therapies, seek services from Home Health Agencies when required. In this manner, the Assisted Living core staff are for resident ADL needs and care primarily, and the intermittent skilled needs of certain nursing interventions and therapies (OT, PT, etc.) are provided by the Home Health Agency.

What occurs when an Assisted Living and a Home Health Agency work collaboratively to serve certain residents with skilled needs, is a bifurcated relationship where roles and responsibilities for resident care and service can get murky. Briefly, here are the two organizational duties for resident care.

Assisted Living Facility

    • Room and Board accommodations including (typically) common areas, dining/meals, some level of furnishings, utilities, access/egress, outside areas, etc.
    • Staff supervision of residents in general and the facility including maintenance and cleaning of the environment
    • Resident assistance or direct provision of ADL cares such as dressing, toileting, bathing, mobility/transferring, eating but not generally, feeding assistance.
    • Social activities for residents and certain social services.
    • Medication management and administration.  Facility may/may not accommodate medication ordering via a pharmacy relationship.
    • Other services such as religion/pastoral care, beauty/barber, transportation, dietetics, physician, banking, etc. may/may not be available.

Home Health Agency:

    • Physical, Occupational, and/or Speech Therapy as assessed by need and as ordered by a physician.
    • Skilled nursing services if required, as assessed by need and as order by a physician.  These services typically include education, various wound treatments, complex catheter care, IV services, ostomy care, pain management, etc.
    • Services are provided as needed by the resident.
    • The Agency must provide training/education to the Assisted Living Facility staff regarding the skilled services/care it is providing.
    • The Agency is responsible for care coordination between the two organizations such that, its orders and services are reflected as required by law, in the resident Service/Care Plan.
    • The Home Health Agency is also responsible for billing insurance or Medicare and for keeping its own medical record.
    • The Agency is responsible for patient supplies as the same pertain to their provision of skilled services.
    • The Agency is responsible for maintaining compliance with Medicare Conditions of Participation and it cannot delegate any related tasks or duties to the Assisted Living unless permitted by regulation. Examples include obtaining orders for care, updating physicians as needed, documenting service provision, reconciliation of medications, etc.

Think of the relationship this way. The Assisted Living serves as the resident/patient’s home. This is no different than if the resident/patient lived in the community, in their own residence.  One could easily create the relationship via a mental picture of the Assisted Living staff as familial caregivers.

The Home Health Agency’s relationship is then, no different than if the patient resided in their own home.  The Agency must assess, develop a plan of care, coordinate visit schedules, document the care, share info. with the patient and the family (Assisted Living staff), and when appropriate, discharge plan and coordinate care for any additional services.

The compliance and litigation perils occur when the relationships between the two become blurry or, when either entity fails to properly meet its separate obligations.  Here are the common risks that I routinely see/encounter.

  • The Home Health Agency fails to incorporate the Assisted Living in its plan of care and to educate the Assisted Living of the same, especially if follow-through is required on ADL education or support.
  • The Assisted Living fails to update its Service Plan for Home Health services, as required.  The biggest error I see here is typically with regard to therapy services and the introduction of any new devices (e.g., walkers, canes, support bars, adaptive equipment).
  • The Home Health Agency delegates physician and family contact to the Assisted Living for Home Health related service needs.
  • The Assisted Living fails to notify the Home Health agency of changes in resident care, conditions, etc. such as noticing a change in skin condition, a change in a medication order unrelated to the Agency’s skilled services.
  • The Home Health Agency fails to coordinate care via discharge planning, even though the resident will remain at the Facility.
  • The Home Health Agency does not do med reconciliation on each visit, believing that the Facility should update the Agency with any new medications or order changes.
  • The Agency is not responsive on a timely basis to resident condition changes including, hospitalizations.  The Agency must be on-call and connected to resident condition changes, documenting and addressed service/care plan updates as required, especially post-hospitalization.

The risks associated with caring for a more complex resident/patient in an Assisted Living environment when Home Health services are initiated are many, as indicated above.  I suggest Assisted Living Facilities try to coordinate their Home Health offerings, where possible, with a few or even, one agency.  With good collaboration between providers, the risks can be minimized.  In any regard, both providers need to understand their roles in resident care and make sure, staff are well-versed in their respective responsibilities.  I advocate tools/cheat sheets if you will, especially for AL staff, delineating “who does what” and where, resources can be sourced if need be.



May 23, 2023 Posted by | Assisted Living, Home Health | , , , , , , , , | Leave a comment

Friday Feature: The Supreme Court and Medicaid Beneficiary Rights to Sue

TGIF! In a little known but important case argued in November of 2022, the family of a Medicaid nursing home resident in Indiana began a suit against a publicly owned nursing home (originally 2016), Valparaiso Care and Rehabilitation. The nursing home is operated by the Health and Hospital Corp. of Marion County. The corporation’s board is appointed by the mayor of Indianapolis and the Marion County Commission and city council. A ruling is expected from the Court soon.

The Talevski family sued the Health and Hospital Corp. after their father was denied readmission to the facility, alleging he was cared for by Valparaiso and other facilities, negligently. He passed away due to complications from dementia but during his initial stay and subsequent travels among nursing homes, the family argued that he was excessively drugged – six psychotropics. The nursing home claimed that the elderly gentlemen became violent, sexually aggressive, necessitating a transfer to another facility more capable of caring for him. The other facility was an hour away from the family. The family said the facility tried to transfer him to another facility even farther away – 2 plus hours. The facility, Valparaiso, refused to take him back.

After the facility refused to accept the readmission, the family sued. One of the daughters is an attorney. The basis of the suit against the Health and Hospital Corp. is that the extensive use of medication, unwarranted and against federal law (SNF Conditions of Participation), and his unauthorized transfers against his rights, violated his rights under federal law. This law, the Federal Conditions of Participation for SNFs, regulates care provided to Medicaid and Medicare beneficiaries. The suit alleges that it is fundamentally illegal to harm patients, provide substandard care, and received Medicaid reimbursement. The suit seeks redress for the rights violations against the County.

At issue is whether a beneficiary can sue a governmental entity for breaches of rights under a federal program or denial of benefits under a federal program such as Medicaid. The argument against the suit is that programs like Medicaid are a joint federal-state funding contract and as such, beneficiaries don’t have the right to sue based solely on this relationship. The question thus is, can individuals interfere with or become a party to, a contractual relationship between the state and federal government?

The implications of this suit are enormous for seniors in the Medicaid program and for providers that care for Medicaid beneficiaries. For beneficiaries, the risk of loss in this case is that they would not be able to sue a government or governmental agency for things as simple as a denial of benefits, even if they are eligible under Medicaid criteria. Administrative procedure may be the only method for addressing complaints or benefit issues.

Providers and governments take the opposite approach indicating that a codification of a right of a beneficiary to sue could create havoc for key programs such as Medicaid waiver (home, community-based services) programs, PACE, Special Needs Plans, etc. They say that lawsuits don’t create a remedy but do ultimately, push unnecessary litigation costs and damage claims into the program such that funding elements would be harmed.

Court watchers see parallels with a decision and the recent Dobbs abortion ruling – a question of rights and access to certain care and services. Some believe the Court may attempt to place limits around certain beneficiaries and litigation such as the ability to sue nursing homes using provisions in the Federal Conditions of Participation as a basis; a patient/resident rights violation. The thought here is that rule enforcement or rule violations when not enforced or addressed, is a regulatory function. There is no likelihood that the Court would speak to any issue of harm due to poor care which, is a different matter and not part of this suit directly.

I’m fascinated by this case as there is so much at stake for Medicaid beneficiaries and providers in the Medicaid program. Its nuances and challenges are many. It is a poster case, in my opinion, for the overall argument that these programs, Medicaid and Medicare, have become too bureaucratic, over-regulated, and incapable of truly supporting and addressing, the real needs of their beneficiaries.

A good synopsis of the case and the issues is here:

April 21, 2023 Posted by | Health Policy and Economics, Policy and Politics - Federal | , , , , , , , , | Leave a comment

Litigation Risk and Assisted Living Facilities

As I mentioned in the prior two posts, litigation activity is on the increase, post-COVID, and some of the most fertile ground for plaintiff’s counsel is Assisted Living. SNFs are still as targeted but as stays decrease and facilities improve care capability, the trend remains level, for the most part. Where perhaps, Assisted Living and Independent Living were in the background, today that trend is changed.

Assisted Living’s litigation fertility is born from a number of conditions. Each of these play an interdependent role in “why” litigation is on the increase.

  • Capacity in many markets is greater than supply of appropriate residents. The industry-wide view for years was “build it and they will come”. The reality is that Assisted Living is by origin, a fairly narrow market need. Its original purpose was to take a resident that was basically independent once, ADL assistance was provided. Either via cognitive declines or physical frailty, the care needs of the resident were such that active engagement of professional level nursing was not required and should the same be required, the resident moved to a nursing home. The demographic today, however, is quite a bit different.
    • For year-end 2022 and the last calendar quarter, Assisted Living occupancy averaged 80.7%, just a tad better than SNF occupancy. Performance and cash flow return for facilities is above this level – generally 85% and above, depending on the size of the facility and whether the same is free-standing or part of a CCRC (source: NICmap).  4Q22-NIC-MAP-Market-Fundamentals-PDF
    • When occupancy lags, the challenge is to maximize occupancy and the two options are to maintain existing residents as long as possible (even perhaps where the same is unwarranted) and/or to admit new residents.  The challenge with admission is that all facilities in a given area likely are chasing the same residents and as is the case with Assisted Living, financial qualification may be difficult.  Costs today for private units plus care can run proximal to SNFs.
  • As facilities seek incremental census gains, the push to admit residents that may not be appropriate for the setting by need or to maintain residents not appropriate for the setting increases the risk of negative outcomes and thus, the risk of litigation.  All too often, facilities may increase care acuity and need within the resident population without matching by staff level and service competency/capacity.  This gap between the care needs of residents and the ability of the staff to meet such needs is a certain risk area for poor care and thus, litigation.
  • As facilities seek to maintain residents in-place, the use of outside agency resources to do so further heightens litigation risk.  For example, the introduction of hospice to maintain terminally ill residents may seem like a good idea yet, if the Assisted Living Facility is not fully aware of each provider’s responsibility for what care needs, residents can “fall through the cracks” in terms of service.  The same is true with Home Health services for skilled rehab or nursing care.

Diane Hislop, RN, Sr. Partner at H2 Healthcare, LLC and head of the compliance practice, identifies some of the key perils she has seen in her practice.  Ms. Hislop’s work also focuses on litigation (defense) on a forensic and expert witness level. “I see facilities admitting and maintaining, more challenging residents with growing diversity in care needs.  If the facility is prepared for such residents by staff number and skill plus other service support (nutrition, therapy, social services, etc.), fine but, often the facility may not have such resources.  The regulations don’t require the same levels of staff as an SNF yet, the resident may be borderline, SNF appropriate”.

Per Ms. Hislop, facilities need to borrow or utilize, many SNF tools and standards, even if not required by regulation, if they intend to take care of more complex residents.  Even without requirements, best practices standards are what facilities should follow, by care needs of residents Hislop said. “The litigation I see is less about what is required and more about what residents needed and did the facility provide the requisite standard of care”.

Ms. Hislop stated that the tricky part of Assisted Living care centers around the goal of maximizing independence for the resident and choice.  Often, families and physicians and extenders, don’t understand the industry standards and are quick to want unwarranted and improper interventions. “Restraints, chemical and physical, are the hardest to explain to families and practitioners, especially when residents are a fall risk.  Things like side rails on beds, bed and chair alarms, forcing residents to sit in certain areas for observation are all in the ‘restraint’ realm.  Families simply don’t grasp this and can run to the ‘facility did not do enough to stop my loved one from falling accusation’.  Sadly, I see practitioners (doctors, NPs, etc.) who facilitate the misunderstanding.  Maximum choice, even for residents with cognitive impairment along with maximum freedom, is the standard.  The difficulty is that the same, allowing the resident as much choice and independence as possible, opens the door for increased bad outcome risk.  The hallmark in U.S. healthcare is that the individual has the right to make his/her own decisions (under most circumstances) even if the same, are ill-advised or perhaps, poor choices”.

Another litigation area Ms. Hislop noted was when other providers such as hospice or home health are integrated into the Assisted Living facility. “I have cases where the litigation is about a bad outcome, an alleged wrongful death and there are two parties involved – for example, a hospice and the Assisted Living facility.  Both have a part of the issue as each, had a distinct requirement of service and as is often the case, one assumed the other would take care of the issue.  For example, a hospice not getting pain control in-place as the resident was dying and being symptomatic.  The Assisted Living facility has basically a role as room and board and to provide meals, administer certain medications, and to update the hospice.  It is the hospice’s duty however, to put the plan in-place to provide for the terminal care needs of the resident and that includes, medication related to the terminal diagnoses.  Delays in care can be problematic”.

Below are Diane Hislop’s key recommendations as the same pertain to litigation risk in Assisted Living facilities.  It was great getting her expert input for this post!

  1. Have clear admission standards and discharge standards for the facility and make families and residents aware of the same.  Only take care of the residents the facility can safely manage by resources.
  2. Use best practice tools and standards for resident care even if the same are not required.  Some are on this blog but others, can be easily found (e.g., fall programs, fall investigations, cognitive assessments, etc.).  
  3. Utilize only a handful of outside resources or fewer if possible.  If the facility is going to offer hospice to residents, pick and partner with a certain agency.  This is possible.  The same is true with home health.  In this regard, the providers can develop a working relationship and a solid interface plan as to “who does what, is responsible for what”.
  4. Educate, educate, educate, staff and families on what is possible in an Assisted Living facility and what is not.
  5. Make sure staff have competencies, tested and trained no less than annually, in key care approaches and delivery, consistent with resident needs.  Don’t short-cut this step with agency staff either and certainly, don’t hustle new staff into roles where they are unprepared for the care needs of residents.

April 4, 2023 Posted by | Assisted Living, Policy and Politics - Federal | , , , , , , , , , | Comments Off on Litigation Risk and Assisted Living Facilities

Litigation and Staffing: What to Know, What to Control

Following up from my last post regarding staffing and litigation risks, this post concentrates on “what we know” and “what we can control”. For example, what we know is that there simply is not enough staff (clinical and even non-clinical) to fill a provider’s vacant positions. The world in general knows this and the press, is oft to repeat a narrative where staff shortages cause negative outcomes, long service waiting times, delayed or deferred admissions, etc. Not a week goes by where I don’t see a news story, on-line, in-print, or on television focused on a health care staffing concern of one level or another.

As I mentioned in the prior post, the heightened alarmism and focus is not helpful, for the most part. For example, I’ve watched Union organizing activity in a number of markets, seeking to organize nurses, based on the staffing issue – not enough and thus, unsafe for nurses and patients. I get the issue, but I don’t see a solution. Raising the issue to a fever pitch, demanding that providers hire more staff that don’t exist, pay more for staff that does exist, etc., isn’t solving the problem. I get that management may even seem callous to the issues and some may be but most senior leaders I talk with are truly trying to do everything they can to improve bedside/patient-centric staffing levels. The simple reality is that there are more openings than bodies capable and willing to fill the positions.

A case in point is recent organizing activity in Wichita, KS (Sedgwick County). Union activity in health care in this area/community has been historically, very low. For professional nurses, it’s been virtually non-existent. At two Ascension hospitals (national Catholic health system) nurses voted within the last nine months, to organize. Here’s a short quote from the Union regarding the push for organization: “We need better staffing, we need Ascension to get serious about recruiting and retaining nurses and we need to have a better safety workplace violence program,” said registered nurse Sara Wilson. “Nurses are in danger when we go to work and Ascension needs to take care of their nurses.” As one would expect, there is truth within that statement but also, to be frank, very little that Ascension can do to create more staff. Provider resources are simply not robust enough to just see the staffing issues as economic. More money isn’t the answer. Ascension closed 2022 with a negative 3.1% margin on losses of $1.8 billion. Among the major health care bankruptcies, one quarter were senior care providers (last several years).

Knowing what we know regarding staff supply, the concern is can some things be done and what can we control. We know money won’t solve the staffing problem as this too, is of finite quantity. Likewise, we also know that money is a substitute concern for the real core issue of simply, not enough bodies for the tasks demanded in patient care. In other words, money becomes the tangible point, but we also know, that money won’t employ more bodies or staff. I know many providers that have RN openings that offer $100K in wage opportunities plus sign-on bonuses and benefits with no takers for these opportunities. A quick Indeed search of Chicago, IL using the job title “nurse” produced 9,133 positions within a 25-mile radius. Similarly, Google searches for nursing positions provide multiple, big dollar references, for travel positions ($5,500 to $7,850 per week). And, according to the Bureau of Labor Statistics, over 203,000 openings will occur every year for at least, the next decade (

What can be done primarily, for any provider, is first and foremost, a concentration on retention. The second thing is to listen to staff, not as a show, but as a real effort in understanding what their concerns truly are. Some are fixable, some are not but all providers should be honest. Open the books so to speak and share the economics. The third, as I have discussed repeatedly, is improve management and reduce bureaucracy wherever possible. An organization can significantly improve its bedside hours (actual) by reducing as many tasks as possible, that have nothing to do with patient care. Trust me, there are many things that health systems and providers require staff to do that has nothing to do with patient care or regulatory requirements. Fourth, analyze the work-flow and make sure that proper duties are assigned to proper staff. I have seen all to many environments where RNs are doing work that could and should be handled by techs, social workers, chaplains, therapists, etc. For example, I can’t even begin to count how many times I have heard about therapists dropping a patient back into his/her room and putting on the call light for nursing to come and toilet the patient or have other care needs met. Crazy. Unless the need was a medication administration, the therapist can and is qualified to assist the patient with a toileting need to get fresh water, transition the patient to bed, etc.

When I see litigation and I see a lot as my firm (H2 healthcare) has an active compliance practice and a nationally known expert in litigation support (defense, not plaintiff), the focus is nearly always on “nursing” not doing something or being somehow, the causation for the bad outcome. Now, with staffing coming to the surface as a root cause (not enough bodies), the question begs, what kind of staff and in what amount. No doubt the focus will be on nursing but perhaps, that focus is rather shallow. As I pointed out in the paragraph above, maybe the staff numbers are better than thought just poorly organized and used (health care is notorious for “silos”) and layers of management.

What a provider can control, aside from numbers of staff which, we know is difficult to totally control, is how staff are allocated especially in relationship to patients and their needs. Below are my top six things providers can control/do with regard to staffing and to reduce litigation risk.

  • Make sure staff in number and capability, match the generalize facility census trend. This means in number (patients) and care needs. I know providers like full beds with patients that garner high reimbursement but, there is a balance. Strike the balance as much as possible and let staff know it.
  • Work as teams – not just as nursing, and therapy, and social work, etc.
  • Stop employing managers that were the “best” clinicians. Employ managers that actually know how to manage, Likewise, give these managers true accountability and authority. They must be able to do their job and not have to “punch up” to get things done. Good management reduces litigation risk.
  • Put staff in positions where decisions are made and give them real results and a “piece of the pie”. Gain share for reduced call-ins, turnover, staff referrals (new).
  • Keep staff apprised of staffing levels and make sure they know how staffing decisions are made, etc. Don’t whitewash the issues. Staff complain about being short-staffed which is the “killer” when it comes to litigation. Too many depositions of nursing staff start with staffing level discussions. Focus on real conversations, daily, about team and everyone being engaged not just “CNAs and Nurses”.

In my next post, I’ll dig a bit deeper into this concept (risk and what can be done), especially concerning the evolving and expanding trend of litigation in Assited Living Facilities.

April 3, 2023 Posted by | Assisted Living, Skilled Nursing | , , , , , , , , , , | Comments Off on Litigation and Staffing: What to Know, What to Control

Staffing, Compliance, and Litigation Risk

Not sure how many folks caught this brief article in McKnight’s….The article link is just below.

Post COVID, all of health care faced a seismic shift in staffing levels. COVID caused wide-spread disengagement in a labor force (clinical) already stressed in numbers. Retirements, especially of nurses, exploded. As COVID abated and the economy began to re-emerge in force with pent-up demand driving consumption, employees like CNAs found more lucrative work in different industries. And, if the work was not more lucrative, it was more culturally satisfying. Let’s face it, CNA work is tough stuff and if a job at Amazon pays as much if not more and the work environment doesn’t involve poop, puke, spit, etc., it may be more appealing (likely is).

Staff shortage (supply) has also been fueled at some levels by two distinct phenomena. First, for some levels such as CNAs and support personnel, expansive government supports and payments became available. COVID via government policy, flooded the world around us with free money or free money trade-offs. For example, for month after month, the Federal govt. made it impossible for landlords to evict tenants that were not paying their rent. This same govt. has frozen, student loan repayments. Expanded unemployment benefits at the state level fueled by Federal supports and direct stimulus payments from States and the Feds made it possible for a large number of people to “not work” and remain comfortable financially. In some cases, the total of the supports exceeded the former take-home pay attained via work.

Second, for nurses in particular, a ton of new “non-bedside” jobs continue to enter the market. It is entirely possible for an RN to find a job within a large clinic, in an insurance company, in a software company (EPIC for example), in product sales, in schools where the working conditions, particularly schedules, are significantly more tolerable with families and other interests, than shift work at a hospital or nursing home. Likewise, the pay and benefits while perhaps not quite as rich as direct patient care, are rich enough, combined with better working conditions, to attract a growing share of nurses.

What the McKnight’s article tells the provider community is that staffing is now a risk area in terms of “litigation” risk. Plaintiff’s attorneys know what providers know, there simply is not enough supply of personnel to meet the demands of providers. Unfortunately, the outlook for any positive movement in greater supply (more staff) is poor in the near term. We’ve known for nearly forever (ok, forever) that staff numbers (sufficient) and quality (properly trained), correlate to patient outcomes (e.g., better care). As patient complexity increases and regulatory pressures for more enriched services and patient choice expand, the probability of negative patient experience and outcomes increases. It is this negative area (outcomes and experience) that drives litigation.

Unfortunately, at a time when more staff is needed and certain shortages exist (some critically so such as in rural areas), the Biden administration is ramping up regulatory pressure to require certain staff levels. As much as this sounds good, it is pure rhetoric, unhinged from reality. Putting pressure on the SNF industry for example to staff more is like pressuring me to dunk a basketball at a regulation high hoop without the aid of a trampoline or ladder – ain’t gonna happen. Creating more negativity in a negative climate is not a solution, even if the govt. demands and in turn threatens, punishment for failing to meet certain staffing levels. Likewise, the pressure is not coming with increased reimbursement necessary to cover higher recruitment and retention costs (e.g., bonuses, wages, increased staff numbers).

So, as I am often asked, what is the answer to the staffing problem? Are solutions available? Can providers truly impact the number and quality of staff available to them? My answer: Yes, there are things that can be done and no, there are no magic bullets. The staffing crisis is a national problem, and it will require Congress, the Administration, and State governments to work collectively and creatively to increase numbers. Regulation demanding providers staff more is not a viable solution. A novel idea would be to shift the focus from tuition loan forgiveness on a blanket basis to free tuition or fractional tuition for nursing programs. Another policy shift must focus on increasing nursing instructors. Again, creativity is required here. Immigration policy shifts for nurses from foreign countries, allowing fluid transition for work could also improve supply.

Providers can also be more creative and responsive. Among the top five reasons I hear for nurses leaving their inpatient positions, crappy management is always in the top two or three. Wages and benefits rarely crack the top ten. Flexibility, engagement in position assignments and schedules, more team approaches to patient care (more bodies engaged including physicians), and increased technology for support are all things I regularly hear from bedside staff.

Below is a link to a presentation I did not too long ago on staffing. The content may be helpful to get a thought process going on how to move forward and increase staff levels in this current environment.

In a soon to follow post, I’ll address the litigation risk issue around staffing and how, providers can mitigate some of the risk through not just staffing but through internal organization and proper use of risk management tools and protocols.

March 30, 2023 Posted by | Policy and Politics - Federal | , , , , , | Comments Off on Staffing, Compliance, and Litigation Risk