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Health Serv Insights. 2016 Apr 12;9:13-9. doi: 10.4137/HSI.S38994. eCollection 2016.

The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes.

Author information

1
R.N. Professor Emeritus of Nursing and Sociology, Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA.
2
Hamilton Professor of Medicine and Director of the Center for Quality Aging, Department of Medicine, Division of Geriatrics, Vanderbilt University, Nashville, TN, USA.; Division of General Internal Medicine and Public Health, Center for Quality Aging, Vanderbilt University, Nashville, TN, USA.; Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
3
Clinical Associate Professor, Director of Community Geriatrics, University of British Columbia Department of Family Practice, Vancouver, BC, USA.
4
Division of General Internal Medicine and Public Health, Center for Quality Aging, Vanderbilt University, Nashville, TN, USA.; Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.; Associate Professor, Department of Medicine, Division of Geriatrics, Vanderbilt University, Nashville, TN, USA.

Abstract

Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality.

KEYWORDS:

market incentives; nurse staffing; nursing homes; regulations; standards

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