Nursing home staffing issues
Any nursing home that admits Medicare and Medicaid residents
must be certified yearly by means of a Centers for Medicare &
Medicaid Services (CMS) survey. The CMS imposes penalties,
including fines, on homes with a high number of deficiencies.
Despite this government involvement, nursing home quality has been
considered substandard over the past three decades. The good news
is that the quality of nursing home care improved following
passage of the 1987 Nursing Home Reform Act (NHRA), according to a
study by University of Alabama researchers, Xinzhi Zhang, M.D.,
Ph.D., and David C. Grabowski, Ph.D.
The NHRA mandated a reduction in the use of unnecessary drugs,
unnecessary physical restraints, any significant medication
errors, pressure ulcers, and incontinence. It also required that
certified nursing homes have licensed practical nurses (LPNs) on
duty 24 hours a day; a registered nurse (RN) on duty at least 8
hours a day, 7 days a week; and an RN director of nursing in
place, as well as 75 hours of training for nurses aides (NAs) and
"sufficient" staff and services.
Nursing home staffing levels jumped substantially following
passage of the NHRA. Per resident day, RN hours increased 18
percent from 0.26 in 1987 to 0.30 in 1993, LPN hours rose 30
percent from 0.46 to 0.60, and NA hours increased 24 percent from
1.61 to 1.99. Also, the proportion of residents with urinary
catheters decreased from 10 percent to 8 percent, and the
proportion of those with physical restraints declined from 39
percent to 23 percent. However, the proportion of nursing home
residents with pressure ulcers increased 8 percent, perhaps due to
a more chronically ill nursing home population in 1993 relative to
1987. The researchers, who were supported by the Agency for
Healthcare Research and Quality (HS13503), based their findings on
analysis of data files before and after implementation of the NHRA
for nursing homes from 22 States.
See "Nursing home staffing and quality under the Nursing Home
Reform Act," by Drs. Zhang and Grabowski, in the Gerontologist
44(1), pp. 13-23, 2004.
Reprints available from the AHRQ Publications Clearinghouse.
these are excerpts from the AHRQ Research Activities,
you can read the full report at
http://www.ahrq.gov/research/jun04/0604RA23.htm
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