No rational person would argue that the elderly relegated to nursing homes in the twilight of their lives are not among our most vulnerable population of Americans. Yet we continue to tolerate the chronic understaffing of most of our nursing homes, decades after government reports exposed this dangerous and unacceptable condition.
As far back as 2002 a Department of Health and Human study found that more than 90 percent of the nation’s nursing homes have too few workers to take proper care of patients. 14 years later we are still confronted with the problem, as recent reports indicate that as many as 95 percent of the nursing homes in America may be understaffed.
In an effort to improve the quality of care in nursing homes, Congress passed the Nursing Home Reform Act of 1987, requiring nursing homes that wish to be certified for participation in Medicare or Medicaid to provide a minimum of eight hours per day of registered nursing (RN) service and 24 hours per day of licensed nursing (LN) service. Federal law requires Medicare and Medicaid certified nursing homes to have a registered nurse (RN) director of nursing (DON); an RN on duty at least 8 hours a day, 7 days a week; and a licensed nurse (RN or LPN) on duty the rest of the time.
However, there are no minimum staffing levels for certified nurse’s aides, who provide most of the day-to-day care. Sadly, this is due largely to nursing home owners or management intentionally understaffing to increase profits. Labor is one of the most costly expenses in a nursing home, so to cut costs, management often dictates unreasonable patient-to-staff ratios.
This is in spite of the fact nurse’s aides are among the lowest paid employees across all industries. A 2012 study from the University of New Hampshire showed the median hourly wage of a nurse’s aide is only $9.33.
As a consequence nursing homes tend to experience high turnover due to unreasonable demands, low wages and meager benefits, thus exacerbating understaffing issues.
This has to change. If a nursing home met only the federal nurse staffing requirements, a resident would receive 20 minutes of nurse time per day. The Centers for Medicare and Medicaid Services (CMS) reported that the optimum staffing level is one hour of licensed nurse time and three hours of nursing assistant time.
Most of these nurse’s aides are disproportionately poor female heads of households trying to do the best they can with the resources they are provided with. Most go above and beyond the call of duty in extending care in spite of unfair work conditions.
Nursing homes should be a place for the elderly and disabled to happily and healthily live the rest of their lives. And nurse’s aides should feel good about the services and comfort they are providing to many lonely and fearful people.
Tragically, as the working poor, both nurse’s aides and the elderly they serve are among the most vulnerable in our society. And each is being taken advantage of by nursing homeowners and management.
We should demand greatness from our nation. Insisting upon adequate staffing for all nursing homes and fair wages for their employees is a good place to start.
Marge Robinson is president of SEIU Healthcare Michigan.
