Registered nurse staffing critical
Numerous academic studies published since 1990 have shown a connection between registered nurse staffing levels and residents’ quality of care and health outcomes.
Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, the nation’s largest nursing homes advocacy group, explained that the importance of registered nurses has grown during the past decade as residents have come into nursing homes from hospitals sicker than in previous years due in part to shorter hospital stays.
The Center analyzed 10 years of health data from Vincent Mor, professor of community health at Brown University, finding that the average sickness levels for residents moving into nursing homes rose 9 percent from 2001 to 2010.
Registered nurses are the only workers with the credentials, education and training to conduct assessments, Grant said. Not having a nurse in the facility at all times means there is no one there who can evaluate a medical situation and respond.
“As a result, residents may not be sent to the hospital when it is critically necessary or be sent unnecessarily, leading to devastating and even fatal consequences,” she said.
Nearly all of the majority-black and Latino facilities were operated on a for-profit basis and on average had larger patient populations than the majority-white nursing homes. Mor said this is in part a reflection of black and Latino seniors having fewer nursing home options in their neighborhoods than white seniors.
“Nursing homes are even more segregated than cities, and cities are very segregated,” said Mor, who has published several articles about the racial distribution of residents in nursing homes.
“The best predictor of which nursing home somebody will choose is proximity to their zip code of origin,” Mor said.
The issue of race compounds the effect of residential segregation, according to Ruqaiijah Yearby, law professor at Case Western Reserve University in Cleveland.
Charlene Harrington, a retired nursing professor from the University of California San Francisco, said that the absence of any federal regulations establishing minimum staffing levels means that large homes, like those that are often the only choices for residents in black and Latino neighborhoods, are not required to have any more staff than smaller facilities.
“So large homes have been historically understaffed, and they have consistently had more deficiencies than small homes,” Harrington wrote in an email.
Registered nurses are also the most expensive workers in nursing homes. As a result, they can be the focus of cost-cutting efforts by for-profit and nonprofit nursing home owners alike, according to Mollot of LTCCC.
In 2012, registered nurses earned an average of almost $68,000, according to data from the Bureau of Labor Statistics.
Certified nursing assistants and orderlies earned less than half that amount.
David Gifford, senior vice president of quality and regulatory affairs at nursing home organization the American Health Care Association, did not address the disparity issue directly, but said improved staffing ratios in nursing homes across the country are one of several factors that are contributing to a “continually improving” quality of care.
But Mor pointed out that poorer quality nursing homes are in less affluent areas with higher concentrations of minorities and often have trouble attracting skilled staff.
“They don’t want to go there, and they have alternatives,” Mor said. “They can go to a hospital and make more money.”