Press Release 2/18/02

Government Study Provides “Compelling Evidence”
For Nurse Staffing Standards in Nursing Homes

Citing a new government study showing that more than 90 percent of nursing homes in the United States do not have enough nurses and nursing assistants to provide essential services and avoid common quality of care problems, the National Citizens’ Coalition for Nursing Home Reform (NCCNHR) today called for government to adopt minimum nursing standards for nursing homes.  This study provides “strong and compelling evidence of the relationship between staffing ratios and quality of nursing home care,” NCCNHR Executive Director Donna R. Lenhoff said. 

A NCCNHR petition drive has collected almost 90,000 signatures from citizens in 49 states who support congressional action to require nursing home staffing ratios.  Lenhoff said advocates for better nursing home care have waited more than a decade for completion of the report, which establishes the number of hours of daily care residents must receive from nurses and nursing assistants to avoid common problems.

“It has long been clear to everyone who understands nursing homes that there is a direct relationship between the quality of a facility and the proportion of nursing staff to residents.  This study provides empirical evidence that creates a compelling mandate for staffing ratios for Medicare and Medicaid nursing homes,” said Lenhoff. “We now know – from this research – how many licensed nurses and certified nursing assistants it takes to provide good care and to avoid costly medical problems.”

Lenhoff noted that the study’s findings validate staffing ratios recommended by NCCNHR in 1998 and incorporated in several bills introduced in Congress and state legislatures. The NCCNHR standards would require residents to receive at least 4.13 hours of direct care from registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) every day. The new government study says a daily minimum of 4.1 hours of total nursing time (RNs, LPNs, and CNAs) is required to avoid common quality of care problems such as bedsores, weight loss, and loss of bodily functions for long-term residents. The report finds that 97 percent of nursing homes do not provide the minimum threshold of nursing care to avoid at least one of these serious problems.

In another analysis, the report concludes that it takes nursing assistants a minimum of 2.8 to 3.2 hours per day to provide essential services such as dressing and grooming, exercising, feeding, toileting, changing wet clothes, and repositioning. More than 91 percent of facilities do not have enough nursing assistants to provide these services, which are also critical to avoid costly and painful medical conditions.

Lenhoff criticized the Centers for Medicare and Medicaid Services for a “weak” response to the findings.  “CMS admits that increasing staffing up to the levels recommended by its report would improve quality,” said Lenhoff, “yet it asserts that no action can be taken until there is further analysis of the ‘tradeoff’ between cost and quality improvement. Nursing home residents and their families live with those tradeoffs every day – tradeoffs that cause pain, suffering and death, as well as expensive medical treatment for problems that could have been avoided with good nursing care.”

Lenhoff said that even without new legislation, the data from the study should help state and federal inspectors cite nursing homes when they have inadequate staff. Such citations are now rare.

NCCNHR supports CMS’s plan to seek improvements in the staffing data made available to consumers, and urges CMS to move quickly to require accurate staff reporting by nursing facilities.

NCCNHR has provided consumer information, technical assistance, and a voice in Washington for nursing home residents, citizen advocacy groups, and long-term care ombudsmen for more than 25 years.   

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You can read the Executive Summary (12 pages in pdf) of  Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes and the Overview of the Phase II Report (December 2001) (17 pages in pdf) here.