Nursing Home Staffing Levels How Much Is Enough
By Phyllis Staff
During the week of February 17, 2002, headlines screamed the news - more than 92% of USnursing homes fail to have an adequate number ofstaff to provide quality care for elderly residents. Newspapers and radio programs based their stories on the new study the Health Care Financing Administration (HCFA) recently provided to the Senate's Special Committee on Aging.
Interesting findings led us to reexamine our current data set ofnursinghome deficiencies. What we found may surprise you; there was no relationship between the level ofstaffing and the number of deficiencies reported fornursing homes. However, there was a relationship between level ofstaffing and percent of residents with pressure sores and physical restraints.
This article is provided to you so you'll have a greater understanding of what these findings mean.
The HCFA Study
Purpose - HCFA's study was performed at the request of the Senate's Special Committee on Aging to determine what minimum level ofnursinghomestaffing was required in order to provide quality care.
Findings - The study reported that a minimum level of staffing, determined to be 2.9 hours of Certified Nursing Aide (CAN) time per resident was required for quality care. A number of measures went into this finding. Among them, a time and motion study examined the time required for basic services such as dressing and toileting.
A correlational study that examined the relationship between pressure (bed) sores andstaffing found that a higher level ofstaffing was related to lowerlevels of pressure sores. This study was somewhat limited by the fact that homes with very lowlevels ofstaffing refused to participate; it may be inferred that the correlational findings would have been stronger with the participation of these homes.
In addition, the HCFA study examined the accuracy of reported level ofstaffing in survey and cost reports. They found that costreports were more accurate than survey results in reflecting an accurate level ofstaffing as determined bynursinghome payrolls.
Limitations - The report was limited by the extent of the data gathered (3 states included) and may not be generalizable across all states.
When Should Staffing Concern You
When the best is yet.net began examining long-term care, we attempted to gather data onstaffing and found that it was extremely difficult to acquire accurate information. Then a well-respected administrator advised us that whilestaffing was important, it was not as good as measure of quality as the level of care residents actually received. We have learned through experience how right his advice was.
So what should you look for when determining the quality of care residents receive?
Look for residents who are well groomed and not lethargic.
Look for residents actively engaged in activities; although eachnursinghome is required to have an activities director, this does not mean that scheduled activities actually occur.
Check the latest survey ratings for the percent of residents with pressure sores. Look for a rating close to zero. We also suggest that you examine the percent of residents with physical restraints because physical restraints may be used as a substitute for staff. Again, look for a rating close to zero.
Look for the quality of interactions betweenstaff and residents. Even though a minimum level ofstaffing is required for quality care, merely havingstaff at that level does not guarantee quality care. Homes may have high numbers ofstaff that do not interact appropriately with residents.
Listen for reactions to resident complaints. Staff who ignore requests and complaints are not providing quality care.
What You Can Do to Find Good Care
Checknursinghome ratings and visit only those with few or, still better, no deficiencies.
Call your state's long-term care ombudsman to get information on resident/family complaints. Although these complaints are not standardized and may include wide variations in severity, a large number of complaints should warn you away from homes receiving them.
Consider non-profit care first. In general, non-profit homes have fewer reported deficiencies and higherlevels ofstaffing than do for-profit homes.
What Else Can You Do?
The current growth in an aging population means that more and more people will require long-term care unless we do something about it now. That something becomes very personal for those of us in the Baby Boomer generation who will, within a few years, be part of the generation potentially needingnursinghome care.
So, how's your health? Do what you can to ensure that your later life will not be complicated by any of the three leading causes ofnursinghome stays: heart disease, stroke and cancer.
About The Author
Phyllis Staff, Ph.D. - Phyllis Staff is an experimental psychologist and the CEO of The Best Is Yet.Net, an internet company that helps seniors and caregivers find trustworthy residential care. She is the author of How to Find Great Senior Housing: A Roadmap for Elders and Those Who Love Them. She is also the daughter of a victim of Alzheimer's disease. Visit the author's web site at http://www.thebestisyet.net
pando19@yahoo.com
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