Performance Improvement 2005. State Experiences with Minimum Nursing Staff Ratios for Nursing Facilities: Findings From the Research to Date and a Case Study Proposal


The purpose of this project was 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 case-mix. Published and unpublished literature was reviewed to describe states’ minimum staffing ratios and their goals, the issues states confronted as they implemented them, and the perceived impact of these ratios on the quality and cost of nursing home care. A small number of key stakeholders and officials at the national level were contacted to corroborate information and further understand issues related to state implementation of staffing ratios. The literature review revealed that 36 states have established minimum nursing staff ratios, and that the remaining 14 states either: 1) used the federal nursing staff requirements when surveying nursing homes that wished to be certified for participation in Medicare or Medicaid; or 2) have used state professional coverage standards for nursing home licensure that are similar to or exceed the federal requirements. The literature review also noted how complex and different the ratios were across the 36 states. They included the type of staff to whom the ratios apply, as well as differences in the ratios and the facilities to which they applied. Recent state activity that included efforts to increase, decrease, or eliminate minimum staffing ratios, or to make ratios more flexible in nursing homes were also discovered. The discussions held with key stakeholders indicated they believed that quality, rather than cost or labor supply, was the dominant concern for most states with recent activity on standards. In addition, some states that have raised nursing home payment rates to address the long-term care labor shortage have imposed staffing ratios to help ensure that increased funding for nursing homes is used to augment staffing in facilities.

PIC ID: 8025; 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

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