Nursing Home Staffing Levels: How Much Is Enough?

by Phyllis Staff

During the week of February 17, 2002, headlines screamed the news - more than 92% of US nursing homes fail to have an adequate number of staff to provide quality care for elderly residents. Newspapers and radio programs based their stories on the new study the Health Care Financing Administration (HCFA) recently provided to the Senate's Special Committee on Aging.

Interesting findings led us to reexamine our current data set of nursing home deficiencies. What we found may surprise you; there was no relationship between the level of staffing and the number of deficiencies reported for nursing homes. However, there was a relationship between level of staffing and percent of residents with pressure sores and physical restraints.

This article is provided to you so you'll have a greater understanding of what these findings mean.

The HCFA Study

Purpose - HCFA's study was performed at the request of the Senate's Special Committee on Aging to determine what minimum level of nursing home staffing was required in order to provide quality care.

Findings - The study reported that a minimum level of staffing, determined to be 2.9 hours of Certified Nursing Aide (CAN) time per resident was required for quality care. A number of measures went into this finding. Among them, a time and motion study examined the time required for basic services such as dressing and toileting.

A correlational study that examined the relationship between pressure (bed) sores and staffing found that a higher level of staffing was related to lower levels of pressure sores. This study was somewhat limited by the fact that homes with very low levels of staffing refused to participate; it may be inferred that the correlational findings would have been stronger with the participation of these homes.

In addition, the HCFA study examined the accuracy of reported level of staffing in survey and cost reports. They found that cost reports were more accurate than survey results in reflecting an accurate level of staffing as determined by nursing home payrolls.

Limitations - The report was limited by the extent of the data gathered (3 states included) and may not be generalizable across all states.

When Should Staffing Concern You

When the best is yet.net began examining long-term care, we attempted to gather data on staffing and found that it was extremely difficult to acquire accurate information. Then a well-respected administrator advised us that while staffing was important, it was not as good as measure of quality as the level of care residents actually received. We have learned through experience how right his advice was.

So what should you look for when determining the quality of care residents receive?

Look for residents who are well groomed and not lethargic.
Look for residents actively engaged in activities; although each nursing home is required to have an activities director, this does not mean that scheduled activities actually occur.
Check the latest survey ratings for the percent of residents with pressure sores. Look for a rating close to zero. We also suggest that you examine the percent of residents with physical restraints because physical restraints may be used as a substitute for staff. Again, look for a rating close to zero.
Look for the quality of interactions between staff and residents. Even though a minimum level of staffing is required for quality care, merely having staff at that level does not guarantee quality care. Homes may have high numbers of staff that do not interact appropriately with residents.
Listen for reactions to resident complaints. Staff who ignore requests and complaints are not providing quality care.

What You Can Do to Find Good Care

Check nursing home ratings and visit only those with few or, still better, no deficiencies.
Call your state's long-term care ombudsman to get information on resident/family complaints. Although these complaints are not standardized and may include wide variations in severity, a large number of complaints should warn you away from homes receiving them.
Consider non-profit care first. In general, non-profit homes have fewer reported deficiencies and higher levels of staffing than do for-profit homes.

What Else Can You Do?

The current growth in an aging population means that more and more people will require long-term care unless we do something about it now. That something becomes very personal for those of us in the Baby Boomer generation who will, within a few years, be part of the generation potentially needing nursing home care.

So, how's your health? Do what you can to ensure that your later life will not be complicated by any of the three leading causes of nursing home stays: heart disease, stroke and cancer.

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