In late 2014, the Association of Health Care Journalists (AHCJ) released updated nursing home inspection data. Many that read the news release were appalled to find that the latest number of deficiencies recorded by the CMS reached 16,806. These ratings, which are often self-reported by the nursing home, don’t even include details such as fines and complaints filed by consumers with state agencies—incidents that are usually left out.
A majority of healthcare professionals attribute the inadequate care in nursing homes to insufficient staffing. Not only is demand for nursing home care increasing due to a surge in the elderly population, Extended life expectancy had lead to a nursing home population that is older, weaker, and in need of more medication and services. Residents are piling in by the dozen, while the number of staff seems to remain the same in so many nursing homes.
So why is the nurse-to-patient ratio so low?
Nurse staffing is still regulated by the Omnibus Budget Reconciliation Act of 1987, which established minimum nurse staffing levels requiring a registered nurse be on duty 8 hours a day, 7 days a week, and a licensed nurse be on duty the rest of the time. However, these minimum requirements don’t take into account the size of the facility, which varies substantially across nursing homes. That means a facility with 400 patients might not even have one registered nurse on duty 24/7.
This is especially frustrating since studies have repeatedly pointed to the importance of registered nurses. With higher registered nurse staffing, patients have fewer bedsores and catheterizations. Patients stay out of hospitals longer and the facilities get fewer deficiencies from state inspectors. Care improves, but it costs less.
There is a current push for legislation that requires more qualified staff in nursing homes. However, nursing homes still face a challenge in finding registered nurses. Facility operators are worried about finding enough nurses, especially in rural areas, since nurses often prefer higher-paying jobs in hospitals.
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