A Glaring Omission At 2015 White House Conference On Aging


What constitutes adequate nursing home staffing levels? My Elder believes that the government should provide the actual ratios.


The positive relationship between nurse staffing levels and the quality of nursing home care has been demonstrated widely. The more staffing you have on the front lines of nursing homes, the safer the residents.

As a result, nurse staffing receives a great deal of attention as a solution to improving nursing home quality. To control cost and improve efficiency, nursing homes want to know the plausible minimum staffing level for providing nursing home quality care. However, one of the difficulties has been establishing evidence-based minimum staffing ratios. Assuming that increasing nurse staffing levels facilitates enhancement of the outcomes of nursing home care, identification of recommended nurse staffing levels becomes important.

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Congress passed the Nursing Home Reform Act of 1987, which gave us a very vague definition of what constitutes adequate nursing home staffing levels. The act required in part, that nursing homes that wish to be certified for participation in Medicare or Medicaid, provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident” However, the Nursing Home Reform Act and resultant regulations do not mandate a specific staff-to-resident ratio or a minimum number of hours per resident day for resident care, and concerns about the quality of care in nursing homes have continued.

Federal Minimum Nurse Staffing Ratios for Nursing Homes

I was hoping that Mr. Obama and CMS (The Center For Medicare and Medicaid Services) would finally mandate Federal minimum nurse staffing ratios for our 1.5 million residents in nursing homes. To my chagrin, this did not happen. Instead, we were given new vague language as to what constitutes adequate staffing levels.

The language reads “Facilities must determine staffing needs based on a competency model that accounts for the number of residents, resident acuity, range of diagnoses, and the content of resident care plans.” This definition is so out of whack with what’s happening in the real world; it’s not funny. Without a Federal mandate on actual ratios, this is unenforceable, assuming that there is anybody out there enforcing the law.

My Elder provides elder advocacy services to families. Talk to us about long-term planning, finding the right home for your loved ones, preventing crisis and abuse, and ensuring they receive the best care possible.