Staffing

Determining an adequate nursing staff level depends on the types of residents in a facility and how dependent they are on staff. A staffing level that is adequate in one facility may not be adequate in another. But in general, the higher the staffing, the better the care.

Because CLHFs accept private payment only and the residents may have conditions that require a lot of nursing care, the nurse staffing hours are generally higher than those for nursing facilities.

Nursing Hours per Resident Day (Data Source: CA OSHPD FIN 08/12/2016)

Nurse staffing level information is reported as staff hours per resident day (HPRD). This is the average number of hours of nursing staff time available to care for residents each day. The total nursing hours include all licensed nurses, nursing assistants, and directors of nursing, and all part-time, full-time, and temporary employees. HPRD is calculated by dividing the total nursing hours worked (excluding time for vacations, sick time, disability, and other paid time off) by the total resident days of care during the year.

Measuring time this way allows the information to be compared across facilities. It does not indicate the number of nurses working at any given time, how well they are organized, or the amount of care given to any one resident. Nurse staffing is usually lower on evenings, nights, weekends, and holidays.

It is essential that adequate staffing is available to meet the care needs at all times in a CLHF. The number of nursing hours may vary according to the type of care provided in the facility. For example, there may be fewer nursing hours for a facility that primarily provides psychiatric treatment.

Staff Wages per Hour (Data Source: CA OSHPD FIN 08/12/2016)

The page shows the hourly wages for licensed nurses (RNs and LVNs), nursing assistants, and administrative nursing staff (directors of nursing and nursing supervisors).

Wages are important for recruiting qualified, experienced staff and are also one reason staff either stay at or leave a job. The more staff that stay at their job, the lower the rate of staff changes at a facility (turnover rate). Facilities with few staff changes may have higher employee morale than those with frequent changes in staff. High morale might result in better quality care.

• Licensed nurses (RN and LVN): Licensed nurses includes both registered nurses (RN) and licensed vocational nurses (LVN). Both these types of nurses are frequently involved in giving care such as injections and medication for pain relief and in monitoring the suitability of a patient’s care.

• Nursing assistants: Sometimes called orderlies or technicians, nursing assistants provide most of the direct care to residents — including bathing, dressing, getting patients to and from the toilet, and eating.

• Directors of nursing or supervisors: The director of nursing is usually a full-time position held by a registered nurse who supervises the entire nursing staff and is ultimately responsible for the quality of care for each resident at the facility.

Citations (Five-Year Period) (Data Source: ASPEN 07/01/2016)

Citations are violations of California standards of care. Check to see if the facility has a higher number of citations than the state average. Citations that were received before the ownership date are not included.

Citations indicate the quality of care provided by a facility because they reflect the problems found by trained inspectors during visits to the facility. The California Licensing and Certification Program (L&C) surveys CLHFs every six years to ensure that minimum standards of care and safety are being met. When a surveyor finds that a standard is not met, the Congregate Living Health Facility receives a citation. CLHFs may also get citations in response to a substantiated complaint.

Complaints (Five-Year Period) (Data Source: ASPEN 07/01/2016)

The page shows substantiated (verified) complaints against a Congregate Living Health Facility that have been filed with and investigated by the California Department of Health Services Licensing and Certification Program (L&C). L&C is responsible for monitoring quality.

A complaint is filed when someone has an objection to treatment or safety conditions in a CLHF. Complaints may indicate the quality of care at a CLHF because they offer a glimpse of the degree of consumer satisfaction or dissatisfaction with a facility. After complaints are investigated by L&C, they are deemed either substantiated (if the inspector found the claim to be true) or unsubstantiated (if there was no proof to support the complaint). If a complaint is substantiated, a citation may be given to the facility. Only L&C may issue citations for violations of the federal and state requirements. Residents, family members, friends, ombudsmen, health professionals, facility staff, and other interested individuals may file complaints.

Average Total Expenditures per Resident Day (Data Source: CA OSHPD FIN 08/12/2016)

The page shows the average amount spent on each client per day.

Percent of Expenditures per Resident Day (Data Source: CA OSHPD FIN 08/12/2016)

The page shows the percentage for each category of the total facility expense. The category expense is divided by the total number of resident days which is divided by the total expenditure. This allows for a fair comparison across facilities.

Facilities are required to report all expenses to the state each year. Facility owners and managers decide how much money to spend on different services and activities. Some of the expenses are fixed, such as leases, rent, interest, and equipment. Other expenditures, such as wages and benefits, are determined by management. These indicators show the percent of expense devoted to the different services and activities for an average resident on a daily basis.

• Direct care: Includes nursing care, social services, activities, ancillary expenses, and wages and benefits for nursing staff. Social services expenses are costs related to providing information and support to residents and their families. Activity expenses include the costs for organized activity programs. Ancillary expenses are all diagnostic and therapy services performed by special departments that are not part of the nursing care expenses. They include patient supplies, physical therapy, respiratory therapy, occupational therapy, speech therapy, pharmacy, laboratory, and other clinical services.

• Other care: Includes maintenance, housekeeping, and dietary expenses. Maintenance expenses include costs for maintaining and repairing buildings, parking facilities and all equipment, minor renovation of buildings and equipment, maintenance of grounds, security, and the cost of utilities. Housekeeping expenses include costs for the cleaning of the interior of the building, laundry and linen services for the facility, and personal laundry service for residents. Dietary expenses include the costs of food, food preparation, and storage, and the delivery of food to residents, including wages and benefits for employees who prepare food.

• Administrative: Includes overall management and administrative costs for the facility that are not nursing, ancillary, social and activity, maintenance, or dietary expenses. They include general accounting, communication systems, data processing, patient admissions, public relations, professional liability and non-property related insurance, licenses and taxes, medical record activities, in-service education for nursing staff, and supplies and equipment.

• Capital expenses: Includes leases and rental of property related to the building, equipment, and improvements. Also includes interest and depreciation of property, equipment, and other assets. The expenses are related to spreading the cost of capital assets over their estimated useful life.

Average Charges per Resident Day (Data Source: CA OSHPD FIN 08/12/2016)

This page shows the actual cost the facility charges for residents’ care per day by the payment source. The average charges per day are calculated by dividing total charges for the year by the number of resident days. Charges are revenue after deductions, which is the amount of money that is received from payers.

• Self-pay: This is the average charge to self-paying residents per day.

• Other: This is the average charge to health insurance, managed care plans, and other payers per resident day.

Resident Days by Payment Source (Data Source: CA OSHPD FIN 08/12/2016)

The page shows the breakdown of the facility’s resident care days payment sources. It is calculated by dividing the number of resident days paid for by each payer by the total number of resident days.

• Self-pay: This is the percentage of resident days paid by individuals for their own care.

• Other: This is the percentage of resident days paid for by health insurance, managed care plans, and other payers.

Financial Status (Data Source: CA OSHPD FIN 08/12/2016)

Financial status shows if the facility is having financial difficulties, which could affect how money is spent and whether or not the facility will stay in business, close, or be sold.

• Net operating income or loss: This is the total amount of money earned from health care operations plus non-operating revenue — after nonoperating expenses have been deducted — excluding taxes and extraordinary items. If it is a positive amount, the facility made a profit. If it is a negative amount, the facility is operating at a loss.

• Operating margin: This is net income divided by health care operating revenue. This is another way of showing the percentage of profits or losses in a facility. Negative numbers indicate a net income loss for the reporting period. Values shown for different agencies can range widely.