Nursing Home Staffing Standards: Their Relationship to Nurse Staffing Levels

Abstract

State staffing standards may not be effective policy tools because they are only one of many factors that affect facility staffing levels. Setting a low minimum HPRD standard may fail to raise staffing, or it may even have a dampening effect on staffing rates in facilities.

The Impact of State Nursing Home Staffing Standards on Nurse Staffing Levels

“…Harrington (2005aHarrington ( , 2005b found that median nurse staffing levels in nursing homes (3.16 HPRD) are greater than state average minimum standards (2.32 HPRD) for the year 1999 to 2001. Mueller et al (2006), reviewing state staffing standards for the year 2004, found that facilities in states with high staffing standards (above 2.50 total staffing HPRD) have higher staffing levels than states with low (below 2.50 total staffing HPRD) or no staffing standards (adhering to the federal staffing requirements), while there is no significant difference in facility staffing levels among states with low and no staffing standards. A study conducted by Harrington, Swan, and Carrillo (2007) found that state RN staffing standards have positive impact on both RN and total nurse staffing levels.…”

“…Chainaffiliated facilities have been reported to have significantly low nurse staffing levels as compared with freestanding ones Mueller et al, 2006;Mukamel et al, 2012). A recent study found that for-profit chains have much lower staffing levels than both nonprofit chains and freestanding facilities .…”

“…Nursing homes are nested within states-the variables of interest are in two different levels including facility level (nurse staffing level in nursing homes) and state level (state nursing home staffing standards). Therefore, HLM is appropriate for the purpose of dealing with the nested data (Mueller et al, 2006). The HLM was conducted by using "Proc Mixed" of SAS program, treating all 51 intercepts (or 51 state effects) as randomly varying.…”

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

“…40 states have established additional staffing requirements beyond the federal requirements [57]. Research has found that higher state minimum nurse staffing requirements were associated with higher nurse staffing levels [57][58][59] and were generally associated with improved resident outcomes [58,60].…”

“…Research has found that higher state minimum nurse staffing requirements were associated with higher nurse staffing levels [57][58][59] and were generally associated with improved resident outcomes [58,60]. State governments have also sought to improve staffing levels through wage pass-through policy, which required that a portion of Medicaid reimbursement or its increase be directed toward staffing improvements, either through enhanced wages or benefits or increasing the number of staff.…”