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Better Staffing: The Key to Better Care

Consumer Voice's Nursing Home Staffing Campaign

About the Campaign

We know that higher levels of staffing lead to better care, but the federal government does not require nursing homes to have at least a minimum number of staff on duty. As a result, every day across the country there are nursing home residents who aren’t getting the care they need because there aren’t enough aides and nurses. Understaffing harms nursing home residents and can lead to pressure ulcers (bedsores), infections, malnutrition, dehydration and injuries from falls.

Nursing home resident experiences and more than 100 studies, articles and government documents have identified the important relationship between staffing and quality of care. Even the best nurses and nurse aides can’t deliver quality care if there aren’t enough of them.

The Federal government has found that nursing homes that do not meet a recommended level of 4.1 hours per day of total nursing time per resident may be putting their residents at risk. This is an issue that affects all of us; more than 40% of Americans who reach the age of 65 will spend some time in a nursing home during their remaining years. 

Our Nursing Home Staffing Campaign educated the public and policymakers about the need for stronger nursing home staffing laws at both the state and federal levels and advocated for such laws to be passed.  

On Tuesday, June 24, 2013, we held a soft launch of our campaign through a virtual kickoff. To view the slides from the presentation, click here.

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4.1- It CAN be done: The Campaign's Social Media Movement

Supporters for the Better Staffing: the Key to Better Care campaign sent us photos saying “4.1 It CAN Be Done!” We wshared these pictures of support with our network through Twitter, Facebook and this website! 



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 Take Action!

In your community:

  • Speak to organizations, community groups, service clubs, faith communities – any group - about the need for more staff in nursing homes and about our Staffing Campaign. Use our ready-to-go PowerPoint presentation. Hand out the consumer fact sheet. Distribute postcards, collect signed cards and mail them to us.* 

  • Ask your members of Congress to support increased nursing home staffing.Visit one or more of your members of Congress in their district. Give them the Staffing Issue Brief. If you need guidance and help arranging and conducting this visit, contact the Consumer Voice (info@theconsumervoice.org or 202-332-2275).

  • Send a letter to the editor to your local newspaper. Use our sample letter.

In facilities:

  • Talk to as many residents and family members as possible about the Staffing Campaign!

  • Hand out the consumer fact sheet.

  • Ask residents and families to sign the postcard to send a message to their members of Congress about the need for more staff – nurses and nurse aides - in nursing homes. 

  • Interview one or more residents using our resident interview materials (see Toolkit below). Everything is outlined for you. It only takes 10 minutes!  

  • Video record or audio tape residents who have specific stories to tell and who are willing to be recorded. 

  • Speak to resident councils and family councils about the Staffing Campaign. Use our ready-to-go PowerPoint presentation. Hand out the consumer fact sheet. Distribute postcards.

Contact Congress:

  • Contact your Senator and your Representatives and urge them to require nursing homes to have at least a minimum number of staff each day to ensure quality care.

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Campaign Toolkit

We've put together the following resources to make your advocacy for more staffing as easy as possible. Click on the links below to access these resources:

  Campaign Description Handout 

  Nursing Home Staffing Campaign: What You Can Do!

  Ways Ombudsmen Can Help to Support the Campaign

  Consumer Fact Sheet on Nursing Home Staffing

  Issue Brief on Nursing Home Staffing

  Campaign Postcard

  Campaign Talking Points

  Campaign Letter to the Editor

  Campaign Powerpoint Presentation

  Campaign Nursing Home Resident Interview Instructions

  Campaign Nursing Home Resident Interview Questions

  Campaign Nursing Home Resident Interview Waiver

  Laws/Regulations and Research Related to Staffing


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Resources on Nursing Home Staffing

Research and Reports

  • The Need for Higher Minimum Staffing Standards (2016)
    This report eviews how nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing.  The report by Charlene Harrington, John F. Schnelle, Margaret McGregor and Sandra F. Simmons discusses the relationship between nursin ghome quality and staffing and the barriers to staffing reform.  Multiple studies have demonstrated a need for higher minimum nurse staffing standards in nursing homes as it is shown to have a positive relationship with nursing home quality.  Yet, many barriers prevent the implementation of higher staffing standards like concerns about cost and enforcement and strong nursing home industry political opposition.

  • Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2005 Through 2010 by Charlene Harrington, Ph.D., et al. The October 2011 edition of this book shows trends in U.S. nursing homes by state for 2005 through 2010. The data are from the federal On-Line Survey and Certification System (OSCAR) reports that are completed at the time of the annual nursing home surveys by state Licensing and Certification programs for the U.S. Centers for Medicare and Medicaid Services. Book sections include: Introduction; Facility Characteristics; Resident Characteristics and Services Provided; Staffing Levels; Facility Deficiencies from State Survey Evaluations; Summary; References; and Technical Notes.

  • The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes (Abstract) This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a four-year period.To view the full study, you must be a subscriber to the database.

  • Nursing Home Staffing Guide (second edition 2002) The Consumer Voice for Quality Long-Term Care guide for residents, families, friends, and caregivers

  • Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes - Report to Congress: Phase II Overview: Background, Study Approach, Findings, and Conclusions This purpose of this report is to complete the Report to Congress that was mandated by Public Law 101-508 which required the Secretary to report to the Congress on the appropriateness of establishing minimum caregiver ratios for Medicare and Medicaid certified nursing homes. A Phase I report of preliminary findings was delivered to Congress in July 2000.

  • Nurse Staffing Standards Recommended by Consumer Voice: In 1998, Consumer Voice's members approved what are widely known as the Consumer Voice Minimum Staffing Standards for nursing homes.

  • Consumer Perspective on Quality Care (Executive Summary) This 1985 document is still a seminal study of quality care as defined by the experts -- nursing home residents themselves. It recounts the research, discussions and findings of a Consumer Voice survey of 400 residents in 15 cities and shows their strong endorsement of nurse staffing as the most important component of care.

State Resources, Regulations & Proposed Staffing Legislation

Archived Resources

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Action Alerts

Urge Your Members of Congress to Include Provisions that Support and Protect Nursing Home Residents in End of Year Appropriations Bill

Take Action December 06, 2022

Tell Your Member of Congress to Hold Nursing Homes Accountable

Action Update July 12, 2022