Minimum nurse staffing ratios for nursing homes

While nurse staffing levels in nursing homes are positively correlated with quality of care, actual staffing standards to achieve optimum cost and quality have not emerged from this research. Federal requirements as determined by the Nursing Home Reform Act only specify minimum staffing levels for the DON, RN, and LPN, but not nurse\u27s aides, although most states have supplemental standards. Applying the concept of decreasing marginal return of labor on quality, the authors examined the relationship between a quality index measure and staffing data by skill mix from the OSCAR database. Non-linear relationships emerged for RNs demonstrating minimum staffing levels to achieve different levels of quality (for example, 0.31 hours per resident per day to achieve a 50% quality level). Due to the non-linear relationship, the additional staffing required to achieve a 75% level of quality may not be financially feasible for most nursing homes given current reimbursement rates