Study Proposes Using Nursing Home Case-Mix to Lead Staffing Decisions
A study led by University of California researcher Charlene Harrington and published in the Journal of the American Geriatrics Society proposed using a nursing home’s case-mix index as a way to set expected daily nurse staffing levels. Under the Patient Driven Payment Model, the Centers for Medicare & Medicaid Services (CMS) assigns 25 letter-based codes to assess residents’ needs, with A indicating residents with the most extensive needs and Y for residents with reduced physical function. CMS adjusts providers’ pay based on the case-mix index a nursing home has been assigned.
The new study found that nine out of 10 nursing homes are failing to meet expected daily nurse staffing levels based on the nursing home’s case-mix index. “On average, registered nurse reported staffing for all facilities was 32% below expected staffing, certified nurse aide staffing was 30% below expected staffing and total staffing (which also included licensed practical nurses) was 22% below expected staffing based on facility case-mix index,” the researchers reported.
A new report on the latest federal staffing data from the Long Term Care Community Coalition (LTCCC) echoed the study’s findings that 9 in 10 nursing homes fall below their expected staffing levels. The new methodology “offers a critical tool for the public to understand what staffing levels a nursing home should actually be providing—based not on arbitrary benchmarks, but on the facility’s own assessment of its residents’ needs,” said LTCCC Executive Director Richard Mollot.
As the fate of the nursing home staffing standard remains uncertain, the researchers suggested using this methodology as a guide to help nursing homes staff facilities based on their acuity.
For more information, read the article in McKnight’s.
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This webinar featured four authors of the report who walked us through their paper, described the new staffing measure, and provided information on how to access this critical data.
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Memo to Nursing Facility Providers
To: Nursing Facility Providers
From: Sherry Culp, Kentucky State Long-Term Care Ombudsman
Subject: Clarification on Transfer or Discharge Notices to KY State Long-Term Care Ombudsman
Date: 6/2/2025
Federal administrative regulation, 42 CFR 483.15, is the governing regulation for facility admission, transfer, and discharge rights. 42 CFR 483.15(c)(3)(i) requires, in part, that before a facility transfers or discharges a resident, the facility must “notify the resident and the resident’s representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand.” The facility must also “send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.”
CMS issued a Survey and Certification memo QSO-25-14-NH on March 10, 2025 that provides further clarification regarding copies of transfer and discharge notices to the Office of the State Long-Term Care Ombudsman. Previous guidance from 2017 indicated ombudsman notification requirements for facility-initiated transfers/ discharges. In the 2025 memo, however, CMS is removing the terms “facility-initiated” and “resident-initiated”. Nursing facilities are now required as of April 28, 2025, to send all discharge notices (including those requested by the resident) to the Kentucky Office of the State Long-Term Care Ombudsman regardless of whether the discharge is resident or facility initiated.
The Kentucky LTC Ombudsman Program has determined that all notices should be sent to the Office of State Long-Term Care Ombudsman at the following email address nhoa@ombuddy.org
The purpose of sending a copy of a transfer or discharge notice to the State LTC Ombudsman is to provide added protection to residents and keep the ombudsman informed of facility practices and activities. In general, notice must be sent to the ombudsman at the same time that notice is provided to the resident and resident representative. Ideally, 30 days in advance. However, for emergency transfers, notice may be provided to the residents and resident representative as soon as practicable, and notice to the ombudsman may also be sent when practicable. Notice to the ombudsman may be sent when practicable—such as compiling a list of emergency transfers and submitting it monthly.
For more information about the Kentucky LTC Ombudsman Program, please visit www.ombuddy.org, contact the State Long-Term Care Ombudsman Sherry Culp at sherry@ombuddy.org. The State Long-Term Care Ombudsman is housed at the Nursing Home Ombudsman Agency (NHOA).
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Issue Brief on Key Facts About Nursing Facilities and Medicaid
An issue brief focused on the impact of the reconciliation bill that was recently passed by the House and its implications for the nearly 15,000 federally certified nursing facilities and the 1.2 million people living in them was issued by the Kaiser Family Foundation (KFF).
KFF’s key facts include:
- Medicaid is the primary payer for over 6 in 10 residents in nursing facilities.
- Medicaid paid for 44% of the $147 billion that the US spent on institutional long-term care in 2023.
- Medicaid enrollees who use institutional long-term care are more likely to be 65+, White, and enrolled in Medicare when compared to those using home care.
Medicaid financing for nursing facilities is complex. Substantial cuts to Medicaid could undermine efforts to increase nursing facility staffing levels.
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Your Senators need to hear from you. Currently, the Senate is considering a reconciliation bill (HR 1), legislation that includes cuts to the Medicaid program that would strip health care from over 16 million people. In addition, the legislation would block the nursing home minimum staffing standard from going into effect until 2035.
These actions would have devastating consequences for all Medicaid recipients, including recipients of long-term care supports and services. Any cut to Medicaid is a cut to all of Medicaid. When states receive less money to pay for Medicaid, they inevitably must cut benefits, implement stricter eligibility requirements, and take other actions to reduce costs. Medicaid pays for roughly half of all long-term care in the United States. Five out of 8 nursing home residents rely on Medicaid to help pay for their care, while it helps 7.8 million individuals remain out of institutions by funding home and community-based services. These cuts would result in countless individuals losing access to these critical long-term care services.
In addition to devastating cuts to Medicaid, the legislation would block the nursing home staffing rule from going into effect until 2035. The recently finalized rule is estimated to save 13,000 lives annually and increase positive health outcomes for hundreds of thousands of nursing home residents. Blocking this rule will result in thousands of nursing home residents continuing to die each year from poor staffing.
We need you to contact your Senators and tell them to oppose HR 1.
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Updated Spousal Impoverishment
The expense of nursing home care — which ranges from $5,000 to $8,000 a month or more — can rapidly deplete the lifetime savings of elderly couples. In 1988, Congress enacted provisions to prevent what has come to be called “spousal impoverishment,” leaving the spouse who is still living at home in the community with little or no income or resources. These provisions help ensure that this situation will not occur and that community spouses are able to live out their lives with independence and dignity.
Under the Medicaid spousal impoverishment provisions, a certain amount of the couple’s combined resources is protected for the spouse living in the community. Depending on how much of his or her own income the community spouse actually has, a certain amount of income belonging to the spouse in the institution can also be set aside for the community spouse’s use.
Following is the minimum and maximum amount of resources and income that can be protected for a spouse in the community in 2025: Updated 2025 SSI and Spousal Impoverishment Standards
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Broad Support for Policies Supporting Affordable Long-Term Care
A cohort survey of a nationally representative sample of people finds, regardless of political affiliation, broad support for policies making care in facilities and at home more affordable (79.0% and 75.4%, respectively). Katherine E. M. Miller, et al, “Support for Care Economy Policies by Political Affiliation and Caregiving Responsibilities,” JAMA Health Forum (published online Jun. 6, 2025). Survey respondents also strongly support increasing the capacity of the paid caregiving workforce (78.3%) among six proposals included in the National Strategy to Support Family Caregivers. The survey finds high bipartisan support for “more incremental efforts to address affordability of care, supporting family caregivers, and investing in paid care workers.”
Read the study at medicareadvocacy.org/yes-to-affordable-long-term-care/
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World Elder Abuse Awareness Day Events (WEAAD)
The purpose of WEAAD is to provide an opportunity for communities around the world to promote a better understanding of abuse and neglect of older persons by raising awareness of the cultural, social, economic and demographic processes affecting elder abuse and neglect. LTC Ombudsmen participated in state and local events to raise community awareness of elder abuse.
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A World Elder Abuse Awareness Day event was held in Frankfort and attended by Governor Andy Beshear on Friday June 13. Ombudsmen staff and volunteers in attendance included: Bethany Breckel, Pam Pangburn, Mary Ashford, Andrew Law, Amy Morris, Paula Wigger, Amanda Grooms, Jodi Holsclaw (Ava), Waynanne Caudill, Angela Zeek and Amanda Hamilton.
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