Nursing Home Guide to Adjusting Nurse Staffing for Resident Case-Mix

Area of Science:

• Gerontology
• Healthcare Management
• Nursing Staffing

Background:

• Nursing homes (NHs) are mandated to provide sufficient nursing staff.
• This study addresses the critical need to align nurse staffing with resident care requirements.
• It quantifies the discrepancy between reported and projected NH staffing levels.

Purpose of the Study:

• To establish a framework for NHs to determine appropriate nurse staffing levels based on resident acuity.
• To calculate the deficit in nursing staff by comparing reported to expected staffing across all US NHs.
• To identify factors influencing staffing adequacy in relation to resident case-mix index (CMI).

Main Methods:

• Estimated expected nurse staffing levels for 25 resident case-mix index (CMI) groups using nonlinear least-squares regression.
• Utilized the latest research data and federal minimum staffing requirements.
• Compared reported staffing data against expected levels for 14,420 US NHs in 2024.

Main Results:

• Expected registered nurse (RN) hours per resident day (HRPD) varied from 0.55 to 2.39 across CMI groups.
• Certified nursing assistant (CNA) HRPD ranged from 2.45 to 3.6, with total nursing HRPD from 3.48 to 7.68.
• Reported RN HRPD was 32% below expected, CNA HRPD was 30% below, and total nursing HRPD was 22% below expected staffing levels.

Conclusions:

• The majority of NHs require increased staffing to adequately address resident acuity.
• Higher CMI groups showed a greater likelihood of meeting expected RN or total HRPD compared to lower CMI groups.
• A significant nationwide deficit in nursing staff exists, impacting the quality of care in NHs.