I just wrapped up a couple of days in sunny California, enjoying the annual QCHF Institute and CAHF Summer Conference. I was honored to be one of the event’s speakers, addressing an issue that I believe is one of the most critical issues facing long-term care facilities in the state of California: managing staffing levels to meet the state’s 3.2 NHPPD (nursing hours per patient day) requirement. California is leading the nation in its enforcement of staffing level standards. State auditors have conducted over 200 staffing audits this year, and the plan is to audit every single skilled nursing facility in the state. On top of this, staffing level litigation is sweeping the state, with high profile cases resulting in massive penalties, followed by a slew of copycat lawsuits.
The audience in my session, “3.2 in the Spotlight: Managing Staffing Levels to Protect Your Organization from Litigation,” expressed a lot of concern and interest in what’s happening with staffing requirements in long-term care. And while there’s a lot of interest in this topic, there is also quite a bit of confusion. Some attendees shared their personal experiences with staffing audits, while others asked questions about what to expect and how to prepare. Stories about discrepancies among staffing auditors and state surveyors, questions on what counts for direct care hours, and opinions on litigation outcomes and processes were all exchanged in the room.
The big takeaway here is that facilities need to tighten their buckles and get prepared. Managing staffing levels is one of the most relevant and most challenging issues in the industry today. Providers are thirsty for proven best practices to help them avoid shortages, prove compliance and ensure care. Things like proper planning and nurse scheduling, documentation, and developing an emergency staffing plan are absolutely critical in this environment.
Working with hundreds of facilities in long-term care gave me the opportunity to share what works and what hasn’t. As I developed my presentation materials, I was also fortunate to be able to spend time with managers from the California Department of Public Health, health law attorneys, providers who’ve undergone audits, and those who have succeeded in complying with the regulations.
There are a lot of opinions, insights, personal experiences, and anecdotes that surround this topic. And while things in California continue to evolve and trickle across the nation, it’s important to remain focused on why staffing levels matter in the first place: to ensure quality resident care. Keep this in mind when diving into the details, figuring out the processes, and implementing change to optimize your staffing levels. Delivering quality care is the foundation for our industry and providing appropriate staff is one avenue to get you on the path to positive outcomes.