Study: Nation's nursing homes understaffed
WASHINGTON (CNN) -- A new federal study has found 97 percent of nursing homes do not have enough staff to provide basic care to patients.
The study, mandated by Congress and presented by the Department of Health and Human Services, found "strong and compelling evidence" to support requiring minimum staffing levels at nursing homes.
But HHS said making such levels a federal requirement may cost too much and instead recommended a market-based solution.
According to the study, patients in nursing homes need an average of 2.8 hours a day of care from nurse aides and 1.3 hours a day from licensed staff members.
The study found 97 percent of nursing homes fail to meet those levels.
It also found 91 percent of nursing homes do not have enough staff to provide routine care in five areas: dressing/grooming independence enhancement, exercise, feeding assistance, changing wet clothes and repositioning residents, and providing toileting assistance and repositioning residents.
Implementing minimum thresholds of care would increase demand for nurses and increase nurse wages by as much as 7 percent, the study said.
But requiring minimum levels of staffing might not be the only answer to improving nursing home care, the study said.
The same level of care could also result from higher staffing expenditures -- higher wages, for instance, might improve the quality of care.
The study's authors said it is still not clear whether it would cost too much to mandate minimum staffing levels, as the HHS said.
A preliminary analysis indicated implementing the new staffing levels would cost about 8 percent more than nursing homes currently spend on staffing.
Other factors besides staffing levels contribute to the quality of care, the study found. For instance, non-nursing staff could be put to work during peak hours, such as mealtimes, and each facility could take a better approach to absenteeism.
High-quality leadership and management that set standards and hold people accountable is another factor in the level of quality care, the study found.
The HHS said the findings provide evidence of "the relationship between staffing ratios and quality of nursing home care" and identified "staffing thresholds that maximize quality outcomes."
It also praised the report for noting the importance of other factors besides minimum staffing levels to providing quality care.
Still, HHS said, making minimum levels a federal requirement might simply cost too much. It expressed hope the problems could be resolved through market demand created by an informed public.
For that reason, the department recommended improved public reporting of nurse staffing information. It said current nurse staffing data are "highly inaccurate" and information on staff turnover is not collected in any database.
"Staffing information should be made available to the general public to make informed decisions when choosing health care providers," the HHS wrote.
Even if the minimum staffing levels mentioned in the nursing home report never become law, it said, "consumers arguably have the right to select homes with this standard in mind."
The HHS also supported the recommendation for improved management and training of nurse aides, saying good management practices sometimes mitigate problems with quality.
The department said it was establishing a multi-agency task force to address issues related to nurse aide training, such as number of hours spent in the classroom, curricula, and access to public supports.
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