Below the Bare Minimum: Elder Justice “No Harm” Newsletter (Volume 7, Issue 3)

In the Elder Justice Newsletter, we highlight citations, including deficiencies related to abuse, neglect, and substandard care, that have been identified as not causing any resident harm. The goal of this brief newsletter is to shed light on the issue of so-called “no harm” deficiencies, which typically result in no fine or penalty to the nursing home.

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule mandating quantitative minimum nurse staffing standards for all nursing homes that accept Medicare and/or Medicaid funding. The rule requires facilities to provide a total of 3.48 hours per resident day (HPRD) of nursing staff time, including at least 0.55 HPRD from registered nurses (RNs) and 2.45 HPRD from certified nurse aides (CNAs).

Despite being a modest step forward, the rule has faced strong opposition. Industry lobbyists and their allies in Congress claim the requirements are too burdensome. In reality, the new minimum is well below what research—and federal law—indicates is necessary to ensure safe staffing. It falls short of the staffing levels residents need not only to live with dignity, but even to survive safely.

Adding to the controversy, two lawsuits have been filed seeking to overturn the rule. In one of these cases, a federal judge has already ruled in favor of the plaintiffs, casting uncertainty over the rule’s future.

This issue of the Elder Justice Newsletter highlights facilities that continue to fall below the 3.48 HPRD threshold—underscoring how far the system still is from meeting even the new, insufficient standard.

This newsletter focuses on the following “no harm” violations:

• Broken dentures, broken promises: Resident restricted to a limited diet.
• Left in soiled conditions: Unanswered call lights lead to delays in care.
• Neglected catheter care: Increased risk of infection.
• “Terrible care”: Unanswered call lights and late medication deliveries.
• Inadequate pressure ulcer care: Gaps in documentation and treatment.
• Missing the mark: The importance of informed consent in resident care.

Do YOU think these deficiencies caused “no harm”? Click to download the newsletter or read it in the PDF below.