On Thursday, Jan. 5, New York State Attorney General Eliot Spitzer released a report on staffing levels in nursing homes. The comprehensive report, which is posted on his Web site found that 98% of nursing homes do not comply with federal recommendations on the staffing needed for resident care.
A large number of New York nursing homes also do not meet the staffing standards set by other states. About 25% do not meet the minimum RN staffing requirements set by the state of Ohio.
Adequate staffing is crucial to the well-being of nursing home residents. According to an article appearing in the Alzheimer’s Care Quarterly, “the benefits of higher staffing levels, especially RN staffing, can include lower mortality rates; improved physical functioning; less antibiotic use; fewer pressure ulcers, catheterized residents, and urinary tract infections; lower hospitalization rates; and less weight loss and dehydration.”
NYSNA released a statement on the day of the Attorney General’s announcement, urging the New York State Legislature to enact legislation (S53/A3543-B) that would require disclosure of staffing levels in hospitals and nursing homes. NYSNA also supports legislation to set staffing standards for nursing homes (S4572/A3263).
Following is the complete text of NYSNA’s statement:
Statement by the New York State Nurses Association in response to report by the New York State Attorney General, “Staffing Levels in New York Nursing Homes”
The New York State Nurses Association applauds the comprehensive report on staffing levels in nursing homes released today by State Attorney General Eliot Spitzer.
The report shows that 98% of New York nursing homes fall below staffing levels recommended for quality care in a 2001 report issued by the Centers for Medicare and Medicaid Services. Many fall below staffing standards set by other states.
What do these numbers mean in the lives of real people? Because of inadequate staffing, thousands of nursing home residents in our state are unnecessarily suffering from pressure sores (which can result in life-threatening infections), are not receiving their medications on time, are left sitting or lying in urine and feces, and are losing their ability to move on their own.
The registered professional nurses who belong to NYSNA have long recognized this problem, which is reaching crisis proportions. They find it appalling that New York State does not have a law specifying what minimum staffing levels or resident care hours should be.
Existing staffing regulations are inadequate and vague.
The state requires that nursing homes “must have a full-time RN as Director of Nursing,” and “shall use the services of an RN for at least eight consecutive hours a day, seven days a week” (10 NYCRR 415.13(a)(2)(b)). This standard applies to all facilities, regardless of their size, and does not include any specific staffing levels for licensed practical nurses (LPNs) and certified nursing assistants (CNAs).
This requirement is clearly inadequate. Under these provisions, a single RN would be responsible for assessing the condition of each resident; checking IVs; completing required paperwork, including comprehensive care plans; and administering medications, tube feedings, and treatments while evaluating residents’ responses to the care that is being delivered. That one RN also would be responsible for coordinating the residents’ care with family members and other members of the interdisciplinary team.
The only other regulation related to staffing levels in nursing homes states that, “The facility shall have sufficient staff to provide nursing and related services to attain or maintain the highest practical physical, mental and psychological well-being of each resident as determined by resident assessments and individual plans of care” (10 NYCRR 415.13).
This vague statement leaves the interpretation of “sufficient staff” to individual Department of Health surveyors, leaving the door open to inconsistent enforcement throughout the state. The enforcement efforts of DOH would be strengthened if New York had well-defined staffing standards for nursing homes.
Legislation is needed to ensure adequate staffing levels in nursing homes.
NYSNA believes that the public has a right to know the current staffing levels in both nursing homes and hospitals. We have promoted legislation (S53/A3543-B) that would require healthcare facilities to disclose the numbers of RNs, LPNs, and CNAs on their staff at different times of the day. This bill passed the State Assembly last year.
In addition, we support S4572/A3263, which would establish staffing standards in nursing homes for all direct care staff, including RNs, LPNs, and CNAs. This would provide surveyors the clear standard they need to ensure safe staffing and would be helpful in identifying systemic staffing problems.
The Attorney General has taken effective action to prosecute nursing homes that have neglected and abused patients. The State Legislature and Governor must take action to strengthen New York’s staffing standards for nursing homes and help prevent patient neglect before it happens.
Contact: Nancy Webber, Director of Communications, 518.782.9400, Ext. 223
With more than 34,000 members, NYSNA is the oldest and largest state nurses’ association in the nation. It is an influential union for RNs, representing nurses in New York and New Jersey. Offering a wide range of services to its members, NYSNA fosters high standards of nursing education and practice and works to advance the profession through legislative activity. It is a constituent of the American Nurses Association and of the United American Nurses, an affiliate of the AFL-CIO.