Consumer Voice: The Nursing Home Staffing Issue

It’s no secret that staffing issues in nursing homes have dominated the Biden Administration’s reforms focus. The coming weeks mark one year since the administration announced their proposed nursing home reforms, and while progress is expected to be slow, the need for staffing changes is more dire than we may think. The National Consumer Voice for Quality Long-Term Care conducted a number of studies and has gathered data to support the call for staffing standards. Here’s what you need to know.

The Staffing Issue

The most logical issue with staffing shortages is that residents get less care. However, it’s been found that the average staff turnover in nursing homes is a huge 52%. This means that the majority of nursing homes must replace more than half their nursing staff every year. High turnover inevitably results in inconsistent care, staff that is unfamiliar with resident needs, confusion and stress for residents, and more. Furthermore, it’s been shown that nursing homes with high turnover also tend to have higher rates of reported abuse.  Nursing homes with a “turnover rate between 50% to 59% (25.8% of nursing homes) are cited for abuse at a rate 1.5 times higher than nursing homes with a turnover rate between 30%-39%.” Again a shocking number, but not an unexpected stat. We already know that low staff means an increased risk of abuse and neglect.

The core of the problem is “poor pay, lack of benefits, high workloads, inadequate training, poor management, and lack of career advancement” as well as poor health outcomes, according to a recent Consumer Voice report. Because of this deeper problem permeating the long-term care industry, a staffing standard seems impractical at best and unachievable at worst. Greater change might be needed to consistently meet staffing standards, but that would mean a larger overhaul of the system as a whole.

In the meantime, Consumer Voice and other advocates are passionate about establishing some sort of across-the-board standard to protect residents and hold long-term care facilities to a higher care standard.

Staffing Standard Expectations

Over the past year much work has been done to establish an agreed upon standard for nursing homes.

“A 2001 CMS study found that nursing home residents require 4.1 hours per resident day (hprd) of direct nursing care to avoid being at an increased risk of harm. The study found that every day residents need, at a minimum, .75 hours of care performed by an Registered Nurse (RN), .55 hours of care performed by a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN), and the remaining 2.8 hours of care to be performed by a Certified Nursing Assistant (CNA). Other studies show a correlational relationship between inadequate staffing and lower quality of care. Further, a Consumer Voice report found that nursing homes adhering to the 4.1 or greater hprd level made up the vast majority of the most highly rated homes.”

The National Consumer Voice

Since the 2001 study, the number of nursing home residents has fluctuated between 1.5 million and 1.36 million. California alone had 93,090 residents in 2022, which would equal out to 381,669 total care hours required to meet the minimum needs of residents. This does not account for special needs, major rehabilitation, or specialized care.

The Centers for Medicare & Medicaid Services uses a Patient Driven Payment Model (PDPM) that accounts for the individual needs of each resident, requiring different payment levels for each resident depending on what their daily needs are. While this ensures the care facility receives the extra funds, it does not guarantee that they are actually used for patient care. However, Consumer Voice does support a staffing standard that would take a PDPM model into account and use it to obtain the appropriate number of staff for each resident.

Additionally, Consumer Voice is advocating for staffing standards that sharply define the duties of the nursing staff versus administrative staff, helping to focus nurse duties to what their education and experience is best suited: i.e. nursing. This would help ensure that residents’ needs are sufficiently met, taking extraneous other tasks away from nurses and alleviating their work loads.

“Any new federal staffing standard should separately mandate staffing hours for each nursing staff category, i.e., RN, LPN/LVN, CNA. In states that have enacted their own staffing standards and treated all nursing staff categories uniformly, the number of RN hours decreased. RN staffing levels are particularly critical to resident health outcomes. Increased RN staffing levels reduce resident incontinence, increase functional improvement, reduce pressure ulcers, reduce the use of antipsychotics, reduce infections, and decrease mortality rates, among other benefits. Additionally, a staffing standard should prohibit non-nursing tasks from being delegated to nurses and it should not include any administrative nursing duties.”

The National Consumer Voice

Dignity for All

In an effort to address the actual needs of both staff and residents, Consumer Voice is hosting a number of webinars. Under the headline Dignity for All, these webinars will feature those working and living within the long-term care industry, offering insight into nursing home life and work environments and what all parties are hoping to achieve with a staffing standard. 

View the webinars below or add them to your calendar!

If you or a loved one have been a victim of nursing home abuse or neglect, call Gharibian Law (877-875-1119) today for a free consultation and the best legal representation.