Experts recommend minimum nurse staffing standards for nursing facilities in the United States

Abstract

The experts concluded that current data show that the average nursestaffing levels (for RNs, LVN/LPNs, and NAs) in nursing homes are too lowin some facilities to provide high quality of care. Caregiving, the centralfeature of a nursing home, needs to be improved to ensure high quality ofcare to residents. Because detailed time studies have not been conducted onthe amount of time that is required to provide high quality of care toresidents, expert opinion is currently the best approach to addressing theproblem of inadequate staffing. Increases in the education level andtraining of nursing staff are also strongly recommended as a step toimproving quality of care and reducing turnover rates in nursing homes.These recommendations are designed for consideration by Congress, HCFAregulators, policymakers, nursing home administrators, and nurses. Ideally,Congress would pass legislation establishing these recommendations asminimum standards for all nursing homes or direct HCFA to establishdetailed minimum nurse staffing standards to ensure that staffing levelstake into account the number and the case-mix of the residents.Alternatively, HCFA could introduce minimum staffing standards through theregulatory process. In 1999 there were a number of efforts at the statelevel to increase minimum staffing levels. Mohler (1999) surveyed selectedstates and found that 21 states had either proposed new legislation or wereconsidering proposals for new legislation or new regulations. InCalifornia, for example, in 1999 the state budget approved $31 million innew state funds (to be matched with $31 million in federal Medicaiddollars) to increase nursing home staffing minimum requirements from 2.8 to3.2 hr per resident day and to increase wage rates. Overall, nursingfacilities need to be held accountable by HCFA for providing adequatelevels and types of staffing to meet the needs of their residents,especially because government is paying for 61% of the expenditures.Adopting these minimum standards will have an important impact on improvingthe quality of the nation's nursing home care. Additional research isneeded to determine appropriate levels and types of staff to provide highquality of care to residents. These studies could test the proposedstaffing standards against existing staffing levels to examine the impactson quality. As new data become available on staffing levels, revisions ofstaffing standards should be made if necessary to ensure that highstandards are maintained.