Staffing at Nursing Homes

Nursing homes house nearly 1.5 million people across the United States. Quality care for residents depends on experienced employees, but understaffing makes a common problem in many facilities. Studies show that nursing homes with more staff provide better care, so this is an avenue worth investigating when choosing a nursing home for a loved one. Knowing legal requirements and other important staffing information helps people make a more informed choice.

Nursing Home Management

The administrator commands the day-to-day operation and organization of a nursing home. When considering a nursing home, people should make sure the administrator has a license to run the facility and inquire about his or her experience, education, and philosophy. Nursing home administrators should have a bachelor’s or master’s degree from an accredited college or university or a combination of an associate’s degree and extensive experience. In addition to the administrator, a nursing home management team typically consists of a manager for various individual departments:

• Activities
• Environmental Services
• Finance
• Food Services
• Human Resources and Staff Development
• Nursing
• Quality Control
• Social Services

Nurse Staffing Requirements

The federal Nursing Home Reform Act (NHRA) requires that nursing homes have at least one registered nurse (RN) on staff for 8 hours per day, 7 days per week. Additionally, the facility must have either an RN or a licensed practical nurse (LPN) on staff for 24 hours each day, but the law does not offer requirements for the number of certified nursing aides (CNAs) on staff.

In addition, no minimum nurse-to-patient ratios exist for CNAs, LPNs, or RNs. Instead, the law states that nursing homes must “provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident.” Essentially, a facility housing 50 residents has the same staffing requirements as one housing 150 residents, which often affects levels of care in larger facilities.

Training Requirements

As mentioned, nursing homes make use of RNs, LPNs, and CNAs. These positions require various levels of training.

• RNs: nursing program associate degree or BS in nursing
• LPNs: at least 1 year of study and passage of licensing exam
• CNAs: minimum of 75 hours of training

Staffing and Nursing Home Neglect

If nursing homes meet the current federal staffing requirements, patients can expect to receive about 20 minutes of nursing care each day. A 2012 congressional report concluded that understaffing in nursing homes contributes to neglect, which can result in “severe bedsores, malnutrition, and abnormal weight loss.” More staff results in more time spent with patients, which alleviates many of these problems.

Optimal Care Plans

In 2000, the Centers for Medicare and Medicaid Services (CMS) recommended at least 3 hours per day of care time for each patient, broken into 1 hour of care time from licensed nurses and 2 hours of care time from nursing aids. Optimally, CMS advocates for one hour of care time from licensed nurses and three hours from nursing aids. While most states offer standards higher than federal requirements, few facilities meet the care plans recommended by the CMS.