Nursing homes in Ky. (and maybe other states) with the most covid-19 deaths had fewer registered nurses

Stanford Care and Rehabilitation reported only 23 minutes of registered-nurse care per patient day in the last quarter of 2019. It's had many deficiencies, and 18 of its residents have died of covid-19.

Nearly 600 people have died from covid-19 in long-term-care facilities in Kentucky, and almost one-third of those have come from just eight nursing homes. One thing those eight facilities had in common was a relatively low number of registered nurses on staff spending less time than average with residents, according to a recent study. It could be the same in other states.

"On average, Kentucky nursing homes reported 45 minutes of RN staff time per resident day during the fourth quarter of 2019, the most recent period for which data is available from the U.S. Centers for Medicare and Medicaid Services," John Cheves reports for the Lexington Herald-Leader. "That was close to the national average. But the eight Kentucky nursing homes with the most covid-19 deaths reported an average of only 24 minutes."

The problem isn't unique to Kentucky, according to a report released last month from the Office of the Inspector General at the U.S. Department of Health and Human Services. "Despite the federal rules, one in every seven nursing homes nationwide failed to meet the minimum nurse staffing levels for at least 16 days in 2018," Cheves reports. The report notes that residents fare more poorly when fewer RNs are on duty during the weekends, and that ombudsmen see increased reports of serious ailments such as urinary-tract infections and bedsores then.

Lack of qualified staff also has repercussions for the pandemic. RNs are "usually are the only ones on a nursing-home staff qualified to create an infection-control plan, spot and assess infections and determine who should see a doctor or go to the hospital," Cheves reports. But RNs are usually paid more than less-qualified staff, and nursing homes are struggling with extra pandemic-related costs even though the federal government has provided some aid. That can make cutting RN hours an attractive way to save money.

Federal law requires only that nursing homes have "sufficient" staff to meet residents' needs. "Some states set their own more rigorous staffing standards for nursing homes, but Kentucky long has resisted such calls, dismissing them as impractical," Cheves reports. "Instead, legislative leaders are promising to pass legal liability protection in the 2021 session to block certain lawsuits over COVID-19 infections."