State Experiences with Minimum Nursing Staff Ratios for Nursing Facilities: Findings from the Research to Date and a Case Study Proposal

This paper reports on (1) what is known about the status of minimum nursing staff ratios, and (2) gaps in knowledge about this type of nursing staff standard and its implementation. To achieve consistency in discussion of the great variety of approaches that states have taken, the authors have imposed the following terminology: They use the term "requirements" to refer to federal staffing requirements; "nursing staff standards" to refer to all of the different types of standards that states use (federal requirement by default, professional coverage standards that do not involve ratios, and ratios); and "nursing staff ratios" to refer to the three types of ratios that are the focus of this study — hours per resident day, staff-to-residents, or staff-to-beds. The paper also describes a qualitative case study methodology for addressing the outstanding questions. [26 PDF pages]