1995-1997 HCFA time studies found about 8 percent of residents were in the RUGs category that requires extensive nursing care. Approximately 50 percent of the time for the extensive nursing residents in the HCFA 1995-1997 national time studies were for licensed staff and of that 57 percent was for RN time. Burke, B. , and Cornelius, B. 1995 and 1997 Staff Time Measurement Study. Multi-state Case mix Demonstration Project, August 1998. Violations of state requirements have been a persistent problem with nursing homes.
Federal standards are minimal for each state.
It is always difficult to balance the need to protect residents with the rights of those residents. It is important that state and federal surveyors act quickly and appropriately when problems are discovered, giving providers adequate time to correct but not allowing them to continue providing sub-standard care. It is not only the responsibility of the state, but also the providers to use their resources to the best benefit of residents. Some states, however, have been creative in using Civil Monetary Penalty money and Intra-governmental Transfer monies to help improve quality of care in nursing homes. Closure and relocation should always be a last resort.