Minimum Nursing Home Staffing Standards: A Good Start, But Not Quite There

Jasmine Travers

The pandemic shone a troubling spotlight on the unnecessary suffering resulting from substandard conditions in nursing homes. On Sep 6, 2023, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule for their widely anticipated minimum staffing requirements for long-term care facilities. A 2022 Nursing Home Staffing study that was convened to inform the development of these requirements followed an urgent plea from the Biden Administration and National Academies of Sciences, Engineering, and Medicine’s Committee on the Quality of Care in Nursing Homes for every nursing home to provide a sufficient number of staff so that the quality of care and safety in nursing homes might be addressed.

Tara Cortes

The proposed requirements.

An abundance of qualitative interviews, surveys, listening sessions, and comments from the public yielded the following staffing requirements:

  1. Minimum staffing hours per resident day (HPRD) for registered nurses (RNs)—0.55 HPRD—and nurse aides (NAs)—2.45 HPRD. Outside of these hours, sufficient additional nursing […]
2023-10-19T10:05:15-04:00October 19th, 2023|Nursing, Nursing homes|1 Comment

A Nurse Ethicist’s Analysis of a Recent Nursing Home Sexual Consent Case

By Douglas P. Olsen, PhD, RN, associate professor, Michigan State University College of Nursing in East Lansing, associate editor of Nursing Ethics, and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

scales of justice/by waferboard, via Flickr scales of justice/by waferboard, via Flickr

An 78-year-old retired state legislator and farmer in Iowa is currently on trial for having sex with his wife, who has severe Alzheimer’s disease, in her shared room in a nursing home. He has been charged with rape.

The case highlights two ethical questions or conflicts:

  • When is protection needed and when is it intrusive and harmful?
  • What are the mental abilities required to consent to sex?

Consenting to sex is not the same as informed consent for treatment. In treatment, a clinician obtains consent to act on (treat) the patient in a way that will benefit the patient. By contrast, proper consent for sex is mutual and both parties benefit.

To extend the comparison: a patient’s decision to consent to treatment is generally made by balancing the benefits, harms, and risks to the individual patient. The decision to engage in sex often involves consideration of another’s satisfaction—it is not unknown for one spouse to agree to sex to please the other, even though he […]

2016-11-21T13:02:41-05:00April 21st, 2015|Ethics, Nursing, nursing perspective, Patients|4 Comments

Military Metaphors, Unnecessary Admissions, New Blogs, Keeping Secrets

It’s a common scenario: a 90-year-old resident of a U.S. nursing home — call her Ms. B. — has moderately advanced Alzheimer’s disease, congestive heart failure with severe left-ventricular dysfunction, and chronic pain from degenerative joint disease. She develops a nonproductive cough and a fever of 100.4°F. The night nurse calls an on-call physician who is unfamiliar with Ms. B. Told that she has a cough and fever, the physician says to send her to the emergency room, where she’s found to have normal vital signs except for the low-grade fever, a normal basic-chemistry panel and white-cell count, but a possible infiltrate on chest x-ray. She is admitted to the hospital and treated with intravenous fluids and antibiotics. During her second night in the hospital, Ms. B. becomes confused and agitated, climbs out of bed, and falls, fracturing her hip. One week after admission, she is discharged back to the nursing home with coverage under the Medicare Part A benefit. The episode results in about $10,000 in Medicare expenditures, as well as discomfort and disability for Ms. B.

There is an alternative scenario, however . . .

That’s from an article in NEJM called “Reducing Unnecessary Hospitalizations of Nursing Home Residents.” In any health care system of as much complexity as ours, there’s bound to be a huge amount of waste. The article gives a good example of how the skills of NPs might be put to excellent use both saving a lot of money for Medicare and making the lives of nursing home residents a whole […]

Do Patients Have a Right to Choose Providers Based on Race?

By mmarcotte51/via Flickr

By Shawn Kennedy, AJN editorial director

We have a wonderful librarian here at AJN who is always on the alert for news about nursing and nurses. Recently she sent me a clipping about a legal case, Chaney v. Plainfield Healthcare Center in Indiana’s Court of Appeals, which has important ramifications for nurses. The court ruled in favor of Brenda Chaney, a certified nursing assistant, and reversed the decision of the lower court that had ruled in favor of the Plainfield Healthcare Center nursing home.

Brenda Chaney brought suit against the nursing home for complying with a resident’s request not to have any black health care workers provide care or enter her room, and leaving her in the care of her automated medical alert system. (She also claimed her firing had been racially motivated. The court agreed that it seemed discriminatory.) The court agreed with Chaney that by acceding to the patient’s wishes, her employer created a hostile workplace and violated her rights. The nursing home claimed it was protecting the patient’s rights and that not doing so “risked violating state and federal laws that grant residents the rights to choose providers, to privacy, and to bodily autonomy.” The court did not agree. The crux of the decision is this:

“In any event, Indiana’s regulations do not require Plainfield to instruct its employees to accede to the racial preferences of its residents. The regulations merely require Plainfield to allow residents access to health-care providers of […]

2017-02-15T15:02:40-05:00October 11th, 2010|Nursing|6 Comments

Nurse’s Aide Brings Nursing Home Sexual Abuse to Light—But Why Did It Take So Long?

NursingHomeAbuseScreenshotA few weeks ago I came across an article in a Virginia newspaper in which reporter Mike Owens wrote about the arrest of James Wright, who was indicted on four counts of aggravated sexual battery against different patients in a nursing home where he worked as a nurse’s aide from 2000 until 2007. The nursing facility, NHC HealthCare – Bristol, is one of 76 facilities owned by National HealthCare Corporation. According to the story, staff members—from peers to administrators—had known about Wright’s abuse of patients for years, but nothing was done to stop it until Patty Davenport, another nurse’s aide, frustrated and appalled that no action was being taken, lodged a complaint with the Office of the Attorney General of Virginia.

To me, Davenport is a hero. But why did this take so long to come to light? A more recent article by Owens reports that several staff have accused the then director of nursing, Anne Franklin, of “trashing” their written complaints about Wright.

Through her attorney, Franklin denies this. I hope it’s not true. I’d like to think that any nurse who learned of such egregious acts would immediately take action to protect patients and blow the whistle long and hard. […]

2016-11-21T13:22:16-05:00September 22nd, 2009|career|1 Comment
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