Costs of Directed Remedies and State Monitoring for Deficiencies

$1,500-$3,000 DON overtime; $8,000-$20,000 in staff retraining and overtime; Medicaid rate cuts (expected from 2025 reconciliation law) mean no recovery budget for compliance costs • $120,000-$200,000 per monitoring cycle (higher CMP risk due to hospice acuity + nursing home overlap); reputation damage affecting admissions • $2,000-$5,000 Compliance Officer labor; risk of private-pay admission loss if deficiency becomes public knowledge (est. $50,000-$200,000 lost revenue per admission diverted to competitor); no mechanism to track whether reputation damage occurred

Director of Nursing coordinates deficiency response via email threads and shift huddles; uses personal notebook to track staff retraining dates; coordinates with compliance officer manually • DON manually organizes staff retraining via sign-in sheets stored in filing cabinet; coordinates with compliance officer via phone; creates handwritten progress notes for state monitoring • Email chains + Excel deficiency tracking spreadsheets + manual correspondence for corrective action plans