Report from The National Academies

The National Academies is a private, nonprofit organization. Researchers examined the nursing home industry to recommend changes to improve the quality of care.  The new 605-page report says the nursing home industry must take necessary changes to improve the quality of care. The nursing home industry provides ineffective care at higher costs with unsafe staffing levels.

Staffing was one of the major focal points of the study. Advocates and experts agree that staffing is too low in sheer numbers, while staff is also untrained and underpaid. Experts from the National Academies of Sciences, Engineering, and Medicine expressed concern:

 “The public is so concerned about the quality of care that most people really fear their family having to be in a nursing home,” Betty Ferrell, a nurse who chaired the report committee, told the Associated Press. “We’re very optimistic that our government officials will respond to what has really been a travesty.”

The report advised that nursing homes should provide at least one registered nurse on duty at all times. That seems reasonable. However, registered nurses in long-term care facilities make, on average, $10,000 less than RNs in acute-care hospitals. The nursing home industry needs different funding, staffing and oversight to meet residents’ needs. The current system is ineffective and fails residents and their families.


The industry needs more transparency, and federal and state agencies need more resources to exercise more oversight of nursing homes that are struggling.

Improving staffing

Federal law requires that nursing homes have sufficient staff to meet residents’ needs. The minimum safe level for direct care nursing is 4.1 hours per patient day. That includes CNAs, LPNs, and RNs. Nursing homes struggle to recruit and retain employees because of poor pay, lack of training, and lack of benefits. Most nursing homes offer low pay and limited benefits. The industry isn’t attractive for employees.

The report calls for better staffing at all facilities, including registered nurse coverage around the clock, with additional RN coverage as needed; a full-time social worker; and an infection prevention and control specialist.

The report recommends establishing minimal and optimal staffing standards for all direct care staff, such as nurses, therapists, social workers and nursing assistants.

Repairing and reimaging facilities

Many facilities are aging and in need of repair. The National Academies call for the construction and renovation of facilities to offer “smaller, more home-like environments,” along with smaller units in larger nursing homes. This will will infection prevention and control.

Oversight and transparency

Nursing home facilities need more oversight. Nursing home information should be accessible in real time, in an easily searchable database.

Enforcing regulations is sporadic and inconsistent. State agencies need to monitor and take immediate action when complaints arise.

Efforts to improve nursing home quality must also consider the voices and concerns of residents and their families.

The study — undertaken by the Committee on the Quality of Care in Nursing Homes — was sponsored by The John A. Hartford Foundation, The Commonwealth Fund, the Sephardic Foundation on Aging, the Jewish Healthcare Foundation, and The Fan Fox & Leslie R. Samuels Foundation.