The Biden Administration will implement a minimum staffing mandate by March of 2023. Direct nursing care is the aggregate time provided by registered nurses, licensed practical nurses and certified nursing assistants. CMS, in a report issued to Congress back in 2001, recommended a daily minimum standard of 4.1 hours of total direct care nursing time per resident: 2.8 hours from certified nursing assistants; 0.75 hours from RNs; and 0.55 hours from licensed practical/vocational nurses. The 4.1 HPPD is a researched, studied, well-established minimum standard and an unofficial baseline.
The most-often cited nursing minimum was proposed in a 2001 study that recommended a 4.1-hour per resident, per day standard. 4.1 hours per patient day of direct care is necessary to avoid neglect and prevent injury. Safe and sufficient staffing starts at 4.1. HPPD.
However, Charlene Harrington, RN, PhD, professor emeritus at the UCSF School of Nursing, told McKnight’s that the nursing minimum should exceed that now, given the increased complexity of today’s nursing home residents. Unfortunately, hundreds of American nursing homes do not supply 4.1 hours of direct nursing care per patient day.
Another study by CMS will include an analysis of the relationship between staffing and quality, the potential costs of a minimum staffing requirement, and a literature review. Nursing home residents suffer complex needs; higher levels of staffing especially RNs; safe staffing prevents infection and mortality. Strong evidence shows that most facilities have adequate resources to increase their staffing levels without additional funding.
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