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Elder Care News
Only Nursing Homes Close to Adequate Staffing are in
States with High Standards
Raising state minimum staffing ratio has a direct
impact on quality of care for senior citizens
May 30, 2007 - The majority of the nation's elderly
and disabled in nursing homes remain in situations where staffing is
well below national recommendations for safe care, a new study found.
But, states that set high staffing standards for elder care in nursing
homes are the only ones that come close to having enough staff nurses to
prevent serious safety violations.
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While no states have ideal nursing levels, those
states with higher Medicaid reimbursements or higher mandated nursing
levels have come closer to meeting the recommendations, according to the
analysis by a professor in the UCSF School of Nursing, published in the
June issue of the journal "Health Services Research."
The study's initial objective was to examine the
relationship between Medicaid reimbursement rates, which many states
have reduced under their cost-containment efforts, and nurse staffing
levels in U.S. nursing homes, according to Charlene Harrington, PhD, RN,
UCSF professor of sociology and nursing and lead author of the report.
She said previous studies have shown a direct
correlation between staffing levels and higher Medicaid reimbursement
for nursing homes, but this is the first to show that states with higher
mandated staffing standards had substantially higher staffing as well.
"For years, families have struggled with low
staffing levels in the nursing homes that care for their elderly family
members, but very few studies have assessed how to change that on a
broad level," Harrington said. "This study shows that the simple step of
raising the state minimum staffing ratio has a direct impact on the
quality of care our seniors receive."
Harrington based her analysis on staffing reports
submitted by nursing homes to the federal government and data from
multiple other sources. She examined the hours that nurses worked in
nursing homes in 2002 and analyzed the data against two variables:
Medicaid reimbursement rates and the range of acuity in patient care.
Medicaid pays for 67 percent of all nursing home
residents in the United States, but only covers 51 percent of the $103
billion in total nursing home costs. Medicare covers 12.5 percent of
those costs, private insurance pays 7 percent and consumers pay 29.5
percent.
In 2002, the average US nursing home had 15 percent
fewer registered nurses per resident than nationally recommended,
Harrington said. That recommendation originated in a 2001 study for the
Centers for Medicare and Medicaid Services. A report by the Institute of
Medicine two years later, titled "Keeping Patients Safe," recommended
that nursing homes be required to meet the levels from the 2001 study to
maintain patient safety.
As expected, this study found that higher
percentages of Medicaid residents correlated to lower total staffing
levels, Harrington said. While it also showed that nursing homes, on
average, do adjust their registered-nursing levels for the acuity of
care needed, most do not increase total staffing for more acutely ill
residents, which also could result in inadequate care.
Overall, nursing homes with more Medicaid
residents, for-profit nursing homes, and those with a larger number of
beds had fewer registered nurses and total nursing staff per patient.
Nursing homes in counties with more elderly residents, more women in the
workforce, and higher incomes had higher registered-nurse staffing
levels.
This study found that nursing homes located in
states that had increased their minimum standards for registered nursing
hours had higher registered-nurse staffing levels. For example, a 10
percent increase in state minimum staffing standards would result in an
increase of 1.66 hours per resident-day (or 16.6 hours for every 100
residents) in actual staffing, if all other factors remain equal,
Harrington said.
"There are several possible solutions to this
problem, including federal or state minimum nursing level requirements
or increases in Medicaid payments," Harrington said. "We now know that a
policy change is an effective way to create an impact, and it might be
an easier solution than trying to change Medicaid payments."
An increase in Medicaid rates of $90 per day would
be needed to increase the RN hours to the recommended levels, the study
found, and a $50 per day increase would be needed to raise total nursing
hours to the recommended levels.
Editors Notes:
Co-authors on the study are James H. Swan, PhD,
Department of Applied Gerontology, University of North Texas; and Helen
Carrillo, MS, UCSF.
UCSF is a leading university that advances health
worldwide by conducting advanced biomedical research, educating graduate
students in the life sciences and health professions, and providing
complex patient care.
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