Minimum nurse staffing ratios for nursing homes.

Abstract

▶ While nurse staffing levels in nursing homes are positively correlated with quality of care, actual staffing standards to achieve optimum cost and quality have not emerged from this research. ▶ Federal requirements a s determined by the Nursing Home Reform Act only specify minimum staffing levels for the DON, RN, and LPN, but not nurse's aides, although most states have supplemental standards. ▶ Applying the concept of decreasing marginal return of labor on quality, the authors examined the relationship between a quality index measure and staffing data by skill mix from the OSCAR database. ▶ Non-linear rela tionships emerged for RNs demonstrating minimum staffing levels to achieve different levels of quality (for example, 0.31 hours per resident per day to achieve a 50% quality level). ▶ Due to the non-li near relationship, the additional staffing required to achieve a 75% level of quality may not be financially feasible for most nursing homes given current reimbursement rates.