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Long-Term Care ConsumersFamily MembersAdvocates
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Specialized Information for:
Long-Term Care ConsumersFamily MembersAdvocates
Chronic understaffing has been a serious problem in nursing homes for decades and has been exacerbated by the COVID-19 pandemic. While there are numerous factors contributing to this problem, one major cause is the lack of adequate minimum staffing standards at both the state and federal levels. Minimum standards ensure that staffing will not fall to a level that would be harmful to residents.
Listen to Nursing Home Residents Talk about Staffing
On Monday, April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule implementing a minimum staffing standard in nursing homes. The culmination of a two-year process, including a request for information, a study, and a comment period, CMS has introduced a staffing rule designed to address the poorest-performing homes in the United States.
The final total staffing rule is well below the 4.2 hours of direct care per resident per day (HPRD) supported by Consumer Voice, and includes numerous waivers and delays in implementation for some areas for at least five years. While Consumer Voice recognizes the rule as an important first step in obtaining adequate staffing in nursing homes, continued advocacy is necessary to ensure all residents receive high-quality nursing care.
Read Consumer Voice's summary of the rule.
Find your facility's staffing rate at https://www.medicare.gov/care-compare/.
Countless studies have documented that residents who live in understaffed nursing homes are more likely to suffer harm and neglect. Our report brings the focus of the staffing discussion back on residents, surveying over 120 nursing home residents in the fall of 2023, asking for their perspectives on staffing and how they are affected by staffing levels daily. The results were striking.
The majority of residents who responded to the survey, 88%, stated their facilities lacked the staff necessary to meet the needs of the residents living in their facilities.
In April 2022, the Centers for Medicare & Medicaid Services (CMS) announced it was beginning the process of implementing a minimum staffing standard for nursing facilities. This standard would require nursing homes to have enough staff to provide each resident with a minimum amount of direct care each day. Since the announcement, CMS has undertaken a study to determine the standard and intends to publish proposed rules in early 2023. When implemented, this standard will be the most significant increase in protections for nursing homes in decades.
Consumer Voice's issue brief examines why staffing is important in nursing homes and what a staffing standard should include.
Consumer Voice's new report examines how nursing homes with higher staff turnover perform poorly in a variety of measures, how staff turnover harms residents, the causes of high turnover, and offers solutions to this endemic problem, such as:
Consumer Voice’s new report looks at federal data regarding nursing home staffing levels and how it affects outcomes for residents. The report found that:
Consumer Voice’s new report, Inadequate Staffing During the COVID-19 Pandemic and Its Catastrophic Effects on Nursing Homes Residents, looks at federal data regarding nursing home residents and documents the true price of inadequate staffing.
The report found that during the pandemic:
On Monday, February 28, 2022, the Biden Administration announced it would be implementing a variety of nursing home reforms, including the creation of a minimum staffing standard in nursing homes. This Consumer Voice report confirms the need for these reforms and the need to address many of the long-standing problems that have plagued nursing homes for decades.
Twenty years after a Centers for Medicare & Medicaid Services (CMS) study found that at least 4.1 hours per resident day (hprd) of direct care nursing staff time are needed just to prevent poor outcomes, state staffing requirements, with a few exceptions, are nowhere near that recommended level. Despite what is known about the relationship between staffing levels and quality care, staffing standards in almost every state remain severely low.
Consumer Voice's 2021 report presents staffing requirements from each state and analyzes how they compare to each other and to levels recommended by research conducted for the federal government.
Residents have waited decades for adequate staffing around the clock. Ongoing and robust advocacy is needed at both the federal and state levels to provide residents with the care to which they are entitled and that they deserve.
Minimum Staffing Levels - The many problems residents can experience as a result of inadequate staffing include higher mortality rates; decreased physical functioning; increased antibiotic use; more pressure ulcers; catheterization; urinary tract infections; higher hospitalization rates; and more weight loss and dehydration
Registered Nurse (RN )Time - Studies have shown a relationship between greater RN presence in facilities and higher quality of care.
Minimum Staffing Levels - A landmark report by CMS in 2001 recommended a daily minimum standard of 4.1 hours of total direct care nursing time per resident.
Twenty-four Hour Registered Nurse - Three Institute of Medicine studies have recommended that at least one RN be on duty at all times.
Neither federal statute nor regulation requires a minimum staffing standard or an RN around the clock. There is no minimum number of direct care nurse and nursing assistant hours per resident per day required by the federal government; nor is there any requirement for a specific ratio of nursing staff to residents.
The chart in Appendix B, State Nursing Home Staffing Standards Chart, presents each state’s staffing regulations. The Guide to the Chart (Appendix A) includes a description of the definitions/terminology used and explains how state standards were converted to hours per resident per day.
State Requirements: Total Nursing Staff Time - With one exception - the District of Columbia, state standards fall far short of the recommended staffing standard.
State Requirements by Type of Nursing Staff -
State Requirements by Shift - Seven states set staffing standards by eight-hour shifts.
Only six states require an RN 24/7 at all facilities, regardless of the number of beds. An additional eight states require an RN 24/7 based on facility size.