Government proposes staffing rules for homes

WASHINGTON — WASHINGTON - Federal health officials have concluded that most nursing homes are understaffed to the point that patients may be endangered. For the first time, the government is recommending strict rules that would require thousands of the homes to hire more nurses and health aides.

In a report to Congress based on eight years of research, the Clinton administration says that understaffing has contributed to an increase in the incidence of severe bedsores, malnutrition and abnormal weight loss among nursing home residents.


Many patients become hospitalized for life-threatening infections, dehydration, congestive heart failure and other problems that could probably have been prevented if the homes had more employees, the report says.

Nursing homes with a low ratio of employees to patients are "significantly more likely to have quality-of-care problems," the study says, and "substantial increases" in staff may be required to ensure that homes do not endanger the safety or health of patients. The 200,000-word report is to be sent to Congress this month.


It recommends new federal standards to guarantee, for example, that patients receive an average of two hours of care each day from nurse's aides. It says that 54 percent of nursing homes fall below this "proposed minimum standard."

The quality of care depends not only on the number of nurse's aides, who help feed and bathe patients, but also on the number of registered nurses and licensed practical nurses, who supervise the aides, the study says.

Accordingly, the report says that nursing homes should have enough registered nurses to provide at least 12 minutes of care a day to each resident, on average. But, it says, 31 percent of nursing homes do not meet that standard.

The government emphasized that the proposed levels of staff were not the optimal levels, but the minimum needed to prevent patients from being exposed to "a substantially increased risk" of poor-quality care.

The report, from the Department of Health and Human Services, was required by a 1990 law and was supposed to be completed Jan. 1, 1992.

But health officials experienced many delays, and the scope of the project grew as they conducted more research and analyzed huge amounts of data from nursing homes nationwide.

Federal researchers said they found that staffing levels were much higher at nonprofit nursing homes than at for-profit homes.

Large nursing home chains that experienced financial difficulties in the past two years, including chains that filed for protection under the bankruptcy law, have cut staff to control costs, the report says.


Nursing homes say it was unrealistic for the government to specify minimum levels of staff when it was providing what they called inadequate payments under Medicaid and Medicare, the programs for low-income people and those who are elderly or disabled.

In addition, nursing home executives say it was hard to attract and retain good workers in a booming economy, when the unemployment rate is at a 30-year low and other industries offer less demanding, better-paying jobs.

The American Health Care Association, a trade group for the industry, says it could not support "minimum staffing ratios" unless the government agreed to help pay the additional cost, which could total several billion dollars a year.