107th Congress

Registered Nurse Staffing: Long Term Care

Message to Congress The ANA supports the immediate enactment of upwardly adjustable, minimum skilled nursing facility (SNF) nurse staffing ratios as a condition of participation in Medicare and Medicaid. At a very minimum, these ratios must require the following: All SNFs must have a registered nurse (RN) on staff and available to meet patient needs at all times (24 hours a day, 7 days a week). Disallow waivers for staffing requirements

Issues Surrounding Registered Nurse Staffing in Long Term Care:

• A number of recent studies have shown disturbing problems with America's nursing facilities. In 1999, the GAO reported that "more than one-quarter of nursing homes have deficiencies that have caused actual harm to residents or placed them at risk of death or serious injury. The Institute of Medicine (IOM) recently released a report (Improving the Quality of Long-Term Care, December, 2000) stating "Multiple studies indicate that staffing in nursing homes is inadequate to provide care that meets consumer expectations or maximizes resident's independence."

• The 2000 IOM report and a longer IOM report published in 1996 (Nursing Staff in Hospitals and Nursing Homes: It is Adequate?) urge Congress to require the presence of an RN in all nursing facilities 24 hours a day, seven days a week. In both reports, the IOM asserts that the relationship between RN-to-resident staffing and quality of care in nursing facilities has been established beyond question.

• The Nursing Home Reform Act of 1987 (Public Law 100-203) promised each nursing home resident the right to expect care and services from the nursing home which would allow him/her to "attain or maintain his/her highest practicable level of physical, mental, and psycho-social functioning." Congress has not required a specific standard setting out the number of hours per patient day that a resident should receive nursing care. Instead, the 1987 law required each nursing home to provide 24-hour licensed nursing services which are "sufficient to meet the nursing needs of its residents."

• Congress has only required facilities to provide the services of an RN for eight hours a day, leaving many residents without access to an RN during the evening and night shifts

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