Some in Congress are seeking to block the nursing home minimum staffing standard from going into effect. These actions would have devastating consequences for individuals receiving long-term care. Contact your members of Congress and tell them to oppose efforts to block the nursing home staffing rule.
Staffing in Nursing Homes
Overview
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.
Protect the Minimum Staffing Rule in Nursing Homes
In May 2024, after decades-long advocacy by residents, their families, workers, and other advocates, a minimum staffing standard was implemented in nursing homes. One analysis estimated that this new rule would save 13,000 nursing home resident lives per year. A minimum staffing standard will require nursing homes to invest in workers, in order to reduce turnover and meet the needs of their residents.
Read the one-pager on the issueFind your facility’s staffing rate
Reports
- Latest Report
- Issue Brief
- For-profit vs Non-profit
- High Staff Turnover
- Federal Data
- Staffing During COVID-19
- State Nursing Home Staffing Standards
Report: The Impact of Understaffing on the Daily Lives of Nursing Home Residents
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.
Why Nursing Homes Need a Minimum Staffing Standard
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.
Better Staffing Is Achievable: A Look at For-Profit vs. Non-Profit Nursing Homes
Thousands of non-profit nursing homes across the country are providing staffing that far exceeds the CMS standard. Read our one-pager about how non-profit homes staff, on average, 23% higher than for-profit homes. In every state, but one, non-profit nursing homes staff higher than their for-profit counterparts.
High Staff Turnover: A Job Quality Crisis in Nursing Homes
Consumer Voice’s 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:
- Increasing staff wages and benefits;
- Reducing staff workloads;
- Providing on-going training; and
- Increasing career advancement opportunities
Staffing Matters
Consumer Voice’s report looks at federal data regarding nursing home staffing levels and how it affects outcomes for residents. The report found that:
- Nursing homes with higher staffing levels have higher overall, health inspection, and staffing ratings.
- As staffing levels decrease in nursing homes, the instances of resident abuse rise.
- Nursing homes with higher RN staffing levels have higher overall, health inspection, and staffing ratings. They also are less likely to have been cited for abuse.
Inadequate Staffing During the COVID-19 Pandemic and Its Catastrophic Effects on Nursing Home Residents
Consumer Voice’s 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:
- The number of residents experiencing pressure ulcers rose 31%
- The number of residents experiencing significant weight loss rose 49%
- The number of residents reporting feeling down, depressed, or hopeless rose 40%
- The increase in the rate of residents receiving antipsychotic medications jumped 77.5%, while the increase in the rate of residents being diagnosed with schizophrenia rose 54%
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.
State Nursing Home Staffing Standards
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.
Key Highlights From the Report
Relationship Between Staffing and Quality of Nursing Home Care
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.
Evidence-based Staffing Recommendations
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.
Federal Statute and Regulation
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.
Analysis of State Staffing Standards
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 –
- No state standard meets the recommended staffing standard of .75 hours per resident day (hprd) for RNs.
- The vast majority of states do not require a specific hprd for Certified Nurse Aides/Nurse Aides (CNA/NAs).
- Direct care staff requirements vary across the country. Eighteen states have no direct care minimum requirement.
State Requirements by Shift – Seven states set staffing standards by eight-hour shifts.
Twenty-four Hour Registered Nurse
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.
