This study describes what is known about the status of states’ minimum nursing staff ratios and findings from case studies that examined states’ experiences with implementing or modifying these standards in a selected number of states. Published and unpublished literature on state standards identified 36 states with established minimum ratios in 2003. Since 1997, 23 states have made changes to their minimum nursing staff ratios. Ten states out of the twenty-three were chosen to find out why the states set, modified, or eliminated their staffing ratios; how the standard in questions was implemented; how compliance was monitored; and the perceived effects of the standards. Site visits were conducted with a set of state official and key stakeholders in each state. Findings reveal that staffing ratios can be implemented or removed in different ways, including thorough passage of new legislation as part of new regulations. Recent changes to state ratios typically came about as a reaction to publicity about quality problems in nursing homes and with the goal of improving the quality of resident care in nursing facilities. However, we found considerable variation across the study states, with substantial disagreement about the best approach among various stakeholder groups.
PIC ID: 8032; Agency Sponsor: ASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy; Federal Contact: Harvell, Jennie, 202-690-6443; Performer: Urban Institute, Washington, DC