Effects of Nursing Shortage

Nursing Hours Per Patient Day: A Critical Measure

The most important measure of the quality of care is the amount of nursing staff available to provide care.  Nursing homes are labor-intensive and require nursing staff that are well-educated, experienced, and compassionate. The effects of nursing shortage directly impact the quality of care received by patients.

The process of Elder care includes:

  • Assistance with activities of daily living (bathing and dressing) and
  • Special nursing services such as wound care, nutrition and incontinence management, medication and behavioral management, and chronic disease management.

Effects of Nursing Shortage on Care Quality

The positive relationship between nurse staffing and quality of care in nursing homes has been demonstrated by a number of studies reported by the Institute of Medicine. Higher staffing hours per resident, particularly Registered Nursing (RN) hours, have been consistently and convincingly associated with the overall quality of care including:

  • Improved resident survival rates, functional status, and incontinence care;
  • Fewer pressure sores and infections;
  • Less physical restraint, catheter, and antibiotic use;
  • Less weight loss and dehydration;
  • Improved nutritional status;
  • Lower hospitalization rates; and,
  • Higher rates of discharge to home.

Financial Motivations Behind Inadequate Staffing

Unfortunately for many nursing home patients, nursing homes routinely and intentionally fail to satisfy staffing regulations. As with most businesses, labor is the most expensive component in operating a nursing home. Hence, the owners and operators of these facilities have a strong financial incentive to staff at inadequate levels at the expense of patient health and safety, which leads to elder neglect.

What is NHPPD?

The profound impact of staffing on the quality of care provided to nursing home patients has been codified at both the State and Federal levels. Among other requirements, a facility must employ sufficient nursing staff to provide a minimum daily average of 3.5 nursing hours per patient day. That means, each patient, on average, must receive at least 3.5 nursing hours per day. The math is simple. The patient census appears in the numerator and the total hours worked by direct caregivers appear in the denominator. Only direct caregivers shall be counted toward NHPPD. Only activities representing “nursing services” may be counted towards the hours worked by direct caregivers. Activities that do not constitute “nursing services” include:

  • Paid or unpaid time spent on meal periods;
  • Staff time spent in non-nursing services functions such as laundry, maintenance, administrative and financial recordkeeping, and administrative maintenance of health records;
  • Staff vacation, holiday, or sick leave time;
  • Nursing services are provided in the same shift as non-nursing services by employees who are primarily engaged in non-nursing services unless the facility provides documentation of the actual time spent on nursing services.

California Nursing Home Staffing Requirements: A Legislative Insight

The California Legislature has mandated that a skilled nursing facility maintain a bare minimum numeric ratio of 3.5 nursing hours per day (NHPPD). (Health & Saf. Code §1276.5, subd. (a).) The plain purpose of mandatory minimum nursing staff levels is to protect the health and safety of residents. The California Legislature and DPH have made it abundantly clear that 3.5 NHPPD is a bare minimum, and additional staff may be necessary to provide adequate care to residents to ensure resident safety. For example,

  • Health & Saf. Code §1276.65 states: (d) The staffing ratios to be developed pursuant to this section shall be minimum standards only. Skilled nursing facilities shall employ and schedule additional staff as needed to ensure quality resident care based on the needs of individual residents and to ensure compliance with all relevant state and federal staffing requirements.
  • 42 CFR §483.30 Nursing Services defines sufficient staff as (1) “The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans.”

In addition, the nursing facility must post the nurse staffing information on a daily basis pursuant to 42 CFR §483.30(e), which includes:

(i) Facility name.

(ii) The current date.

(iii) The total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift:

(A) Registered nurses.

(B) Licensed practical nurses or licensed vocational nurses (as defined under State law).

(C) Certified nurse aides.

(iv) Resident census.

The facility must, upon oral or written request, make nurse staffing data available to the public for review at a cost not to exceed the community standard. 42 CFR §483.30(e)(3).

NHPPD California: Understanding Staffing Norms

In California, NHPPD (Nursing Hours Per Patient Day) plays a crucial role in maintaining the quality of care in nursing homes. The concept of NHPPD California isn’t just a number; it’s a regulatory standard that ensures each resident receives adequate attention and care. But what is NHPPD exactly? It refers to the total amount of nursing time available per patient in a nursing facility. The standard addresses both the quantity and quality of staff, impacting everything from routine care to critical medical services.

California Nursing Home Staffing Requirements

California nursing home staffing requirements are among the most stringent, reflecting the understanding of the effects of nurse staffing on quality of care. These mandates aim to ensure that there is an adequate nurse-to-patient ratio in nursing homes in California. The state has established minimum staffing requirements for nursing homes, with the goal of preventing issues that arise from understaffing, such as neglect, medical errors, and decreased patient satisfaction.

How to Improve Staffing in Nursing Homes

Improving staffing in nursing homes is a multifaceted challenge. Facilities must consider recruitment processes, work conditions, competitive wages, and continuous training opportunities for staff. Strategies to address the nursing shortage in California include offering incentives for nurses to remain in the field, providing opportunities for career development, and implementing technology to streamline tasks and improve efficiency. Facilities also need to maintain transparency regarding their staffing levels and practices, as this impacts public trust and their reputation.

Behind the Scenes of Nursing Home Neglect

Behind the scenes of nursing home neglect often lies a complex mix of inadequate staffing, insufficient resources, and sometimes, managerial indifference. When facilities fail to meet the minimum staffing level in a nursing home, the consequences can be severe. Residents may suffer from a lack of basic care, such as hygiene assistance, meal support, and timely medical intervention. The effects of inadequate staffing in nursing can extend to emotional neglect, where residents feel isolated, ignored, or forgotten.

Financial Impact of Nursing Shortage

The financial impact of the nursing shortage is also a critical concern. Insufficient staffing often leads to burnout, high turnover rates, and increased reliance on temporary staffing solutions, all of which can be costly for facilities. Additionally, the effects of nursing shortage extend to patient outcomes. Poorer health outcomes due to inadequate care can result in legal liabilities, further straining a facility’s finances. Understanding and adhering to the California nursing ratio law is not just a legal obligation; it’s also a financial imperative.

Legal Use of Healthcare Information

In the context of healthcare, the legal use of healthcare information directly impacts patient care. Ensuring proper staff levels and care standards requires accurate, timely, and confidential patient data. This information is crucial for staffing assessments, quality control, and compliance with state and federal regulations, including those governing NHPPD.

Tackling the Challenges: A Proactive Approach

In conclusion, the complexities of the effects of short staffing in nursing and the broader implications of the nursing shortage and quality of care require a proactive, multifaceted approach. This includes not only meeting but exceeding the minimum staffing requirements for nursing homes. It involves strategic planning, resource allocation, and an unwavering commitment to the highest standards of patient care. By understanding and addressing the factors behind the nursing shortage, facilities can better serve their residents and set a standard for excellence in the healthcare community.

Conclusion of the Effects of Nursing Shortage:

When making the difficult decision about where to place your loved one for skilled nursing care, whether it be for short-term care or long-term care, ask the nursing facility to view the daily NHPPD numbers. Shop around and compare the NHPPD numbers. Generally, a higher level of staffing equates to better care.

If you suspect a loved one has been injured, neglected, or abused while in the care of a Southern California nursing home, assisted living facility, or caretaker, or if you are the victim, it is important to contact Moran Law immediately to discuss your case.