In 2003, two nursing home residents were admitted to a nursing home in New York with pressure sores. Both residents were given care plans that included regular skin assessment, turning and positioning.
Within months, the residents developed multiple pressure sores and one resident developed renal failure partly caused by skin breakdown. The state inspector attributed the failure to administer care plans to a “systems breakdown” caused by staffing issues including lack of communication, high turnover and use of agency staffing.
Staffing rations and quality of care are strongly related. Residents need staff for nutrition, disease management and turning and positioning to prevent pressure sores. The 1996 Institute of Medicine report, “Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?” found that staffing ratios have a great effect on the nutrition of nursing home residents. Nursing assistants in understaffed nursing homes are unable to patiently feed each resident. As a result, residents are more likely to suffer from dehydration, malnutrition and associated conditions.
Reports linking quality of care and staffing ratios date back to at least 1971. The U.S. Government Accountability Office has issued multiple reports calling for increased staffing ratios. New York nursing homes have particularly low levels of staff. The Center for Medicare and Medicaid Services (CMS) study “appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes: Phase II Final Report” found that 98% of nursing homes in New York have nursing levels that fall in the range where quality of care was shown to suffer.
Now is the time for legislation to mandate staffing ratios on both state and federal levels. The over 65 population is increasing both nationally and in the state. A population projection by the U.S. Census Bureau shows that the population of people in New York age 65 and older will increase by 60% between 2004 and 2030. Not only is the aging population growing but the diabetes epidemic will also increase the number of older people who will need help with activities of daily living and disease management-services provided by nursing homes. We must ensure that nursing homes will have sufficient staff to care for our aging population as they grow in number and dependency.
Legislation to require ratios has not passed nationally or in this state because the numerous reports linking staffing ratios with quality of care. Over the past six years, bills mandating staff staffing have been pending on both the state and federal levels.
The arguments against mandating staffing ratios include the perceived high cost of staffing and the nursing shortage. However, numerous studies have shown that increasing staffing ratios significantly reduces operating costs and that understaffed homes in fact contribute to the nursing shortage: it many not be that there are no nurses available, but rather that so many refuse to work in nursing homes because of the poor working conditions prevalent in understaffed homes.
A report issued by the Long Term Community Care Coalition in 1998 detailed “91 Ideas for Reducing Costs: Enhancing Revenue, and Maintaining Quality in Nursing Homes”, details how bladder training reduced rates of incontinence which reduced the costs of laundering soiled sheets and supplying diapers (in addition to restoring dignity to residents). A 2006 study in the “Journal of The American Medical Directors Association, “Effects of continuous activity programming on behavioral symptoms of dementia” found that continuous activity programming and additional staff decreased the use of psychotropic medications and led to further decreased agitation and improved sleep.
Interviews with nursing home staff demonstrate their genuine care for the residents they care for but they do not have time to attend to all of their needs. In fact, nurses blame poor working conditions caused by insufficient staffing for the high average turnover rate. An article in the January 2007 issue of the New York State Nurses Association’s New York Nurse reports that many nurses are working part-time or have changed professions due to poor working conditions. Increasing staffing ratios should be seen as part of the solution for the nurse shortage.
Nursing home residents, their families and nurses have been waiting while others are debating issues such as cost and nursing shortage. It is time for our representatives to acknowledge the link between quality of care and nurse staffing ratios. Residents are suffering from lack of care. Nursing home staff is sustaining injuries due to staff shortages. In order for nursing home residents to receive the care the need and for staff to be able to properly care for residents, they must be given a guarantee that our nursing homes will be staffed appropriately.