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Nursing Home Federal Staffing Requirements

How much staff is needed in a skilled nursing facility to provide reasonable care? Of course, the specific answer depends on who you ask. Since "he who pays the piper calls the tune" and federal and state governments provide the bulk of reimbursement to skilled facilities, facilities must follow some basic governmental rules regarding the quality of care. Medicare and Medicaid reimbursement for skilled facilities began in 1965. Growing concerns of poor resident care led the federal government to ask the Institute of Medicine (IOM) to study the issue of skilled nursing home care and the government funds. In 1986, the IOM produced a report "Improving the Quality of Care in Nursing Homes". The IOM report suggested stronger governmental oversight and some basic standards that would apply to all facilities receiving these funds.

In 1987 the government attached some strings to such funds by the passage of the Nursing Home Reform Act. This act was initially a separate bill, but was then rolled up into one massive piece of legislation called the Omnibus Budget Reconciliation Act of 1987 (OBRA).[i The very first sentence under Residents Rights Subsection .10 states "The resident has a right to a dignified existence..." Also in Subsection .15 Quality of Care, the act states "(a) Dignity. The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individuality." A dignified existence surely means that staff will answer call bells, help to feed and change residents in a timely fashion and provide basic care. However, these complaints of nursing home neglect are very common in Greensboro and other communities.

As for a specific staffing provision, Subsection .30 requires that, "the facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and plans of care." First, this provision is mandatory as it says "must have sufficient staff." Second, it refers to the "highest" state of well-being. Third, there is what appears to be a balancing provision of "practicable." While one-on-one care would most likely provide the highest level of well-being, it isn't feasible.

All of the above establish general requirements, and the primary specific federal staffing requirement is also found in Subsection .30: the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week, and a full time Director of Nursing. So, look at the staffing documents when you walk into a nursing home. The number of staff and schedules may be posted. Understaffing is the number one cause of nursing home abuse. Don't stand by and let that happen. If you suspect nursing home abuse call the attorneys at Roane Law. We will give you free advice to at least help give you some peace of mind.


[i] 42 C.F.R Section 483