LAWRENCE — A national coalition’s report says one-fourth of Kansas’ 300 nursing homes were categorized as problem facilities due to substandard care and persistent compliance issues.

The Long-Term Care Community Coalition’s latest summary, based on the federal Centers for Medicare & Medicaid Services’ five-star quality rating system, showed 24.6% of nursing facilities in the United States were designated “problem facilities” after receiving a one-star rating. In Kansas, 25.2% of nursing homes had that lowly score based on inspection reports, staffing levels and other quality measures.

In Kansas, six of 10 nursing homes were owned by for-profit companies. Three-fourths of the state’s troubled nursing homes were of the for-profit variety, the coalition said.

“If we’re outperforming the nation, that’s a really bleak picture,” said Dan Goodman, executive director of Kansas Advocates for Better Care. “Particularly we’re concerned with the lack of staffing of these facilities. Kansas currently ranks 46th in the nation as far as staffing long-term care facilities compared to other states. The amount of staffing in those facilities directly impacts the overall care that residents receive.”

Goodman said on the Kansas Reflector podcast there was an unsettling correlation between low staffing levels and the frequency in use of medications to control nursing home residents. Those drugs could be detrimental to the health and quality of life for elderly people, he said.

He said staffing shortages in long-term care facilities also contributed to failure to deliver routine care, including basics of brushing teeth or using the restroom, and could extend to frequency of dangerous falls as well as premature death.

Federal staffing mandate


In April, the U.S. Centers for Medicare & Medicaid Services, also known as CMS, published a rule that would reform long-term nursing care facilities serving 1.2 million residents across the country. The agency order would increase the required staff-to-resident ratio, mandate a registered nurse be onsite 24 hours per day and expand regulations related to assessments of the facilities.

The requirements, to be implemented over a three-year period, prioritized safety and health care quality, while taking into consideration workforce challenges some facilities may experience, especially those in rural areas. The rules on overall staffing would take effect in 2026 for urban facilities and in 2027 for rural facilities.

U.S. Sen. Roger Marshall, a Kansas Republican, has sought to reverse the new long-term care regulations embraced by the administration of President Joe Biden. Marshall, who is a physician, said the regulations were “unnecessary” and would lead to closure of nursing homes in Kansas.

“These overly burdensome rules will be devastating to nursing homes in Kansas, especially those in rural areas,” Marshall said. “The unfunded mandates will further increase operating costs and exacerbate the existing nursing shortage. There is no evidence that these regulations will improve the quality of patient care. It just doesn’t make sense.”

Marshall and U.S. Sen. Jerry Moran, R-Kansas, endorsed a congressional resolution that would, if passed, nullify the nursing home rules adopted by CMS.

Marshall co-sponsored a bill that would prohibit the U.S. Department of Health and Human Services from implementing the minimum staffing rule in instances where imposition of the order diminished access to care. The bill was endorsed by LeadingAge Kansas, the Kansas Hospital Association and the Kansas Health Care Association/Kansas Center for Assisted Living.

“Our nursing homes are committed to providing the highest quality care in Kansas and stand ready to work on real solutions for the continuing workforce crisis in long term care,” said Rachel Monger, president and CEO of LeadingAge Kansas. “The federal government cannot mandate staff where none exist.”

Inside the numbers


Goodman, of Kansas Advocates for Better Care, said the federal rating system indicated 77 of the 306 nursing homes in Kansas were “problem” facilities. The analysis indicated one-third of for-profit nursing facilities in Kansas had low scores. In other words, he said, 58 of 183 for-profit nursing homes were rated as problematic.

Goodman said investment companies, including real estate firms, were buying into the nursing home industry. Operators of those companies didn’t have a background in health care delivery and wouldn’t necessarily have a grasp of what it meant to provide compassionate assistance to residents, he said.

“Individuals are suffering, and probably dying sooner than they should be,” Goodman said.

A federal government report in November concluded for-profit nursing facilities tended to have lower quality ratings, fewer registered nurses and more safety violations. In 2021, the National Bureau of Economic Research said residents of nursing facilities owned by a private equity firm had a 10% greater chance of dying compared with residents living in another type of long-term care facility.

Libby Hastings, communications coordinator at Kansas Advocates for Better Care, said updated federal guidelines for long-term care facilities — opposed by Marshall and Moran — shouldn’t be viewed as burdensome if the objective was to provide quality care to these Kansans.

Hastings said the workforce situation in nursing homes would be improved if direct-care workers were viewed as skilled labor, and provided paid health insurance and opportunities to advance in the business organization.

She said families should consult the federal rating system for nursing homes before making personal decisions, but also consider who owned and operated the nursing homes.

“I think for consumers it’s important not to go just solely based off the five-star metric system,” Hastings said. “I think it’s important to look at your inspections. You should go visit the facilities unannounced.”