State-Initiated Nursing Home Nurse Staffing Ratios: Annotated Review of the Literature


The purpose of this project is to inform federal and state policymakers about what can be learned about the implementation and enforcement of state minimum nursing staff ratios for nursing homes, and related issues, such as labor shortages and resident casemix. The experiences of states that have already grappled with the complexities of setting, monitoring, and enforcing minimum staffing ratios could be instructive. The project will describe the states' minimum ratios and their goals, the issues states confront as they implement the ratios, and the perceived impacts of these ratios on the quality and cost of nursing home care. This paper provides an annotated review of the published and unpublished literature on state standards. Its purpose was to identify states with minimum nursing staff ratios and to learn how this type of standard is being implemented. [43 PDF pages]

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