The Long Term Care Community Coalition (LTCCC), a private New York based organization dedicated to improving care and conditions in nursing homes, is calling upon state and federal legislators to pass laws requiring nursing homes to meet staffing standards to improve the quality of care in the industry. In a June 2013 report titled, “Nursing Home Policy Brief: Mandatory Minimum Safe Staffing Requirements Needed to Protect Nursing Home Residents Now & in the Future,” the LTCCC points out that many studies have indicated that there is a direct link between staffing levels and the quality of care residents receive in nursing homes. By mandating that nursing homes maintain minimum staffing levels, the report contends that such laws will reduce the number of injuries and hospitalizations among elderly residents due to lack of care.
The report states that based upon recommendations provided by the Center for Medicare and Medicaid Services (CMS), nursing homes should be required to maintain staffing levels that allow for residents to receive 4.1 hours of direct care per day. In a CMS report to Congress, it was determined that residents who received less than two hours of nurse aide care per day had much higher rates of avoidable hospitalizations and bed sores. From 1999 to 2005, registered nurse hours in facilities fell by 25 percent while licensed practical nurse hours fell by 22 percent and certified nurse’s hours decreased by seven percent.
The LTCCC’s report indicated that decreases in staffing levels results in poor care. For instance, because many residents have limited mobility, they need to be repositioned periodically to prevent pressure sores, which can lead to complications such as cellulitis, infections or osteomyelitis. Improving staffing levels would reduce such incidents. Moreover, facilities with a low number of staff often have patients who are malnourished, which can lead to infections and even death. In addition, improving staffing levels would lead to better incontinence care. When patients’ incontinence briefs are left unchanged, such a lack of care degrades their dignity and increases their chances of developing pressure sores. As a result, the LTCCC argues that mandatory minimum staffing requirements in the nursing home industry would prevent residents from suffering harm or injury due to negligence.
Many opponents to minimum staffing level requirements claim that such laws would increase costs dramatically and overburden the Medicaid program. However, the LTCCC’s report argues that staffing requirements would save money for nursing facilities and the government in the long run. For instance, the report claims that minimum staffing levels would reduce the number of patients taking psychotropic drugs, which are often used to manage patients’ behavior. Having the appropriate number of staff would allow for more one-on-one time with patients with behavioral issues. As a result, not only would facilities save money on costly medications, but they could also prevent serious falls, which are highly linked to sedating psychotropic medications. In addition, nursing homes would save money on legal settlements for neglect or abuse of residents. According to the report, the average nursing home settlement costs $400,000. Minimum required staffing levels would cut down on such lawsuits.
The Nursing Home Reform Law, passed in 1987, requires that patients “be provided with services sufficient to attain and maintain his or her highest practical physical, mental, and psycho-social well-being.” The LTCCC asserts that mandated minimum staffing levels will help nursing homes to meet their requirements under this federal law.
The 2013 LTCCC report is available online.