90% of Nursing Homes Lack Adequate Staffing, HHS Study Finds
More than 90% of U.S. nursing homes have too few employees to take "proper care" of patients, a shortage that is expected to worsen in the future, according to a new HHS study. The New York Times reports that the report found "strong and compelling" evidence that nursing homes with lower ratios of staff to patients provide "substandard care" more often than nursing homes with higher ratios of staff to patients. Patients in nursing homes with lower staff-to-patient ratios suffer bedsores, malnutrition, weight loss, dehydration, pneumonia and serious blood-borne infections more often, the report found. According to the report, most nursing home patients require an average of 4.1 hours of care per day -- 2.8 hours from nurse's aides and 1.3 hours from registered nurses or licensed practical nurses. Dr. John Schnelle, co-author of the report, said that under that standard, nursing homes would need to have one nurse's aide for every five or six patients from 7 a.m. to 11 p.m. Many nursing homes today have only one nurse's aide for every eight to 14 patients, he said. The report found that more than 40% of nursing homes would need to increase their nurse aide staffing by 50% or more in order to reach the "minimum threshold associated with their resident population." It also found that nursing homes would have to hire 77,000 to 137,000 registered nurses, 22,000 to 27,000 licensed practical nurses and 181,000 to 310,000 nurse's aides to reach the recommended staffing levels. Reaching "adequate" staffing levels would cost $7.6 billion per year, an 8% increase over current spending levels, the report found. Congress ordered HHS to conduct the study in a 1990 law. The Clinton administration issued preliminary findings in July 2000, and the Bush administration plans to send Congress a final report and recommendations within a month.
Although one chapter of the HHS report, drafted by experts in geriatric medicine, recommended "some minimum staffing ratio to protect nursing home residents," the Times reports that the Bush administration does not plan to mandate such ratios. Administration officials said, "We do not think there is currently sufficient information upon which to base a federal requirement for all certified nursing homes," adding that "any requirement would have to be balanced against cost." According to the report, "it is not currently feasible" for the federal government to require nursing homes to maintain a minimum ratio of staff to patients. The administration will publish information on the number of employees at nursing homes, hoping that "nurse staffing levels may simply increase due to the market demand created by an informed public." The administration also plans to encourage nursing homes to improve their "management techniques" to boost staff "productivity." Nursing homes have lobbied Congress to increase reimbursements for Medicare and Medicaid beneficiaries and to block reductions in Medicare reimbursements to nursing homes set to take effect Oct. 1. Several members of Congress have said that they would support increased reimbursements, provided that nursing homes use some of the additional funds to hire more nurse's aides. Medicaid beneficiaries account for about two-thirds of nursing home patients. Medicaid and Medicare help cover the cost of care for about three-fourths of nursing home patients, the Times reports.
Consumer advocates and nursing home executives agree that U.S. nursing homes have a "severe shortage" of staff but "disagree on the solution," the Times reports. Donna Lenhoff, executive director of the National Citizens' Coalition for Nursing Home Reform, said, "The government admits that increasing staff to the levels recommended in the report would improve quality, but then asserts that no action can be taken until there's further analysis of the tradeoff between cost and quality improvement. That's a very weak response." Lenhoff said that nursing homes could "save money and lives" with additional employees. However, nursing home executives said that they would "have difficulty finding the additional workers." Suzanne Weiss, senior vice president of the American Association of Homes and Services for the Aging, said that she opposes minimum staffing ratios "because they do not take account of the fact that some patients are sicker and more disabled than others" (Pear, New York Times, 2/18).