Dr. Ash

👦🏾⚕️⚖️🇺🇲🏳️‍🌈🇮🇳🇨🇦🥗🍨

[Dr. Ash @ashvinvk]

Congress just repealed the federal nursing-home staffing minimum.

In February, the rule that would have required nursing homes to provide at least 0.55 hours of registered-nurse time per resident each day went away. Blocked through 2034.

So we pulled the real numbers from CMS into Placet. Here is what facilities actually staff right now.

Across 14,289 skilled nursing facilities reporting, the median resident gets about 35 minutes of registered-nurse time per day. Not per shift. Per day.

45% of facilities (6,549) already staff below that 0.55 line that just got thrown out. They were under the floor before anyone removed it.

And it tracks quality almost perfectly:
1-star facilities: about 28 minutes of RN time per resident per day
5-star: about 46 minutes

Nearly 19 more minutes a day at a 5-star than a 1-star. The nurse is the person who catches the small change before it becomes a hospital transfer. Minutes matter.

If you are touring a facility, ask how many RN hours per resident per day they staff. They report it to CMS. You can check the answer on every facility page at https://t.co/E1Ls83V6zb.

Building Placet because this data should not be this hard to find.

#ElderCare #NursingHomes #Transparency

[Dr. Ash @ashvinvk]

How fast do nursing homes churn through their nurses?

CMS tracks it. The share of RNs who left each facility in the past year. We pulled the latest into Placet.

Across 13,549 U.S. skilled nursing facilities reporting, average annual RN turnover is 46.4%. Nearly half the registered nurses, gone every year. 2 in 5 facilities (5,321) lost at least half their RNs.

And turnover tracks quality ratings almost perfectly:

▸ 1-star facilities: 54.7% RN turnover
▸ 3-star: 46.2%
▸ 5-star: 38.6%

A 16-point staffing-stability gap between the highest- and lowest-rated facilities. Continuity is care: the nurse who's seen your mom every week notices the change in her gait. A nurse on week two doesn't.

31 facilities reported 100% RN turnover.

If you're touring a facility, ask: "What's your RN turnover rate?" They know the number — they report it to CMS. Now you can check their answer on every facility page at https://t.co/E1Ls83UyJD, plus a state-by-state report:

https://t.co/a00T4zp3Ha

Building Placet because this data should not be hard to find.

#ElderCare #NursingHomes #Transparency

[Dr. Ash @ashvinvk]

CMS flags a nursing home with an "abuse icon" when federal inspectors substantiate abuse, neglect, or exploitation of a resident.

We pulled the live federal data into Placet. Across 14,713 CMS-certified skilled nursing facilities in the U.S., 1,462 currently carry the flag — about 1 in 10 nationally.

Split it by ownership and the gap is hard to ignore:

▸ For-profit SNFs: 11.4% are abuse-flagged (1,231 of 10,837)
▸ Non-profit + government SNFs: 6.0% (231 of 3,876)

That's 1 in 9 vs. 1 in 17. Nearly 2× the rate at for-profits.

A few caveats we want to be honest about:
- The icon means a substantiated finding, not an active danger today. Some flags are years old.
- Ownership type isn't destiny. Plenty of for-profit SNFs run clean, and some non-profits have problems.
- The federal abuse icon only applies to skilled nursing — assisted living and personal care homes are state-regulated and don't carry it.

But if you're a discharge planner narrowing a list, or a family member touring options, ownership type belongs in the conversation. Search the full list of 1,462 abuse-flagged SNFs — filter by state, see overall star rating — at https://t.co/FimaW0muJc

Building Placet because this data should not be hard to find.

#ElderCare #NursingHomes #Transparency

[Dr. Ash @ashvinvk]

You don't have to take the first bed offered. If no safe placement is found, families can appeal a discharge through Medicare's Quality Improvement Organization. That gets you at least one more day to look. Most families never hear this exists.

https://t.co/X7ml2bl2jm

[Dr. Ash @ashvinvk]

A nursing home license does not mean they can handle everything. Some homes have no nurse on weekends. Some cannot do wound vacs. Ask straight: "Do you have a nurse trained for this, on every shift?" That answer matters more than the license.

https://t.co/X7ml2bl2jm

[Dr. Ash @ashvinvk]

Ask one question on the phone: "What is your 30-day return-to-hospital rate?" Medicare tracks this for every nursing home and posts it on Care Compare. A good home will tell you the number. A great one is proud of it.

https://t.co/X7ml2bl2jm

[Dr. Ash @ashvinvk]

If you allocate capital, work in healthcare finance, or just want to know what your retirement plan owns: help us connect landlord to care.

Open methodology. No facility pays for placement. DM me.

[Dr. Ash @ashvinvk]

Your 401(k) probably owns part of a nursing home. You don't know which one. Neither does your fund manager.

Public companies hold the real estate under thousands of America's nursing homes. The data is in CMS and SEC filings. Nobody connects it to care.

We're working on it.

[Dr. Ash @ashvinvk]

In our data: about 310 nursing homes name a publicly traded landlord in their CMS ownership filings. Most public companies route ownership through shell LLCs that hide the parent name. The real number is bigger. We can't see it yet.

[Dr. Ash @ashvinvk]

Your dad has been in the hospital a week when the discharge planner asks where you'd like him to go. You don't know - you've never picked a nursing home before.

The thing is, there's a lot you can know about a place before you walk in. How many nurses are usually on the floor. Whether the state inspector found anything serious. How families before you described the care. None of that shows up in the directories families are given.

https://t.co/E1Ls83UyJD (Place-It) puts the data where you can find it.

[Dr. Ash @ashvinvk]

Nobody teaches you how to pick a rehab facility. You just get handed a list and told to call around. I got tired of watching families make this decision blind, so I wrote down everything I tell them in the room.

https://t.co/H8eq8pqbe9

[Dr. Ash @ashvinvk]

@Creatify_AI Aurora - yes I want

[Dr. Ash @ashvinvk]

@NotionKristen PARA

[Dr. Ash @ashvinvk]

@PhilaParking @PhilaParking is all talk with no walk. This is what the entirety of 17th Street in North Philadelphia looks like. Starting south of route 13

[Dr. Ash @ashvinvk]

@DPearsonPHL What is transit inequity?

[Kelley Yemen @tychenemesis]

Please take this PennDOT State Transportation Survey and let PennDOT know you're transportation funding priorities https://t.co/Wmva6wKZFp https://t.co/vuBJlg8MBP

[Dr. Ash @ashvinvk]

@JoshShapiroPA How can we hold those that murder and enable murder accountable as a state? @PhillyMayor @Darrell_Clarke as a city?

Thank you all for what you do. https://t.co/U8h7eOItRz @PhillyInquirer

[Dr. Ash @ashvinvk]

Policy recommendations https://t.co/lf6WVmfaiw

[Dr. Ash @ashvinvk]

@PhilaStreets please use warm lights 3200K and not daylight/white lights for neighborhood lighting.

Warm lights let neighbors sleep and tolerate streetlights better, the visibility is good for all ages (if cataracts are managed), it's safer for bird migration and dark sky gazing