Analysis
Topic: Nursing Home Staffing Ratios
Sponsor: Leland
Committee: Health Policy
Position: The department does not support the bill.
Problem/Background: Demographic changes in the United States and Michigan pose a significant challenge to the nursing home industry. The fact that more people are living longer
has resulted in a sharp increase in the severity of illness, disabilities and dementia of many
nursing home residents. Also, many patients who might formerly have been cared for in a
nursing home but who are in better health thanks to modem medicine are turning to alternative
home and community-based long term care options. Meanwhile, trends in health care, such as
the trend toward shorter hospitals stays, have brought people to nursing homes for shorter term
rehabilitative and post-hospitalization care.
Staffing to provide the care required by Michigan's nearly 60,000 nursing home residents has
frequently been advanced as an issue for the industry. Nurse aids make up the bulk of nursing
home staffs. The pay for these positions is relatively low and turnover is high. The
occupational injury rate for nursing home workers is also high. Nationwide, injury and illness
rates in nursing homes has increased by 62 percent since 1980.
Increased staffing levels in nursing homes would not only permit increased care and supervision
for nursing home patients but would also help prevent the tragic incidents of patients from
wandering away from a home, which does happen occasionally.
Description of the Bill: The bill amends the Public Health Code to increase nursing home staffing as follows:
Additional registered professional nurses are required to be employed by a nursing home
"when applying for licensure", with at least one licensed nurse on duty at all times.
The Nursing Director is required to supervise nursing staff.
The number of care hours are increased from 2.25 to 2.65 hours of nursing care by
employed nursing personnel per patient per day.
Required ratios for patients to "unlicensed nursing personnel" are:
Morning Shift--Not more than 8 to 1;
Afternoon Shift--Not more than 12 to 1;
Night Shift--Not more than 15 to 1.
Required ratios for "licensed nursing personnel" are:
Moming and Afternoon Shifts--Not more than 10 to 1;
Night Shift--Not more than 50 to 1.
Facilities providing three or more hours of care with unlicensed nursing personnel per
patient per day would be exempt from the staff to patient ratio requirements.
Summary of Arguments:
Pro: Increased nursing home staffing would permit better care for residents and reduce the
incidence of tragic deaths of patients wandering away from nursing home facilities.
Con: The bill is unnecessary, because the quarterly staffing report for the fourth quarter of 1996
(October through December) shows that nearly 90 percent of the 437 facilities surveyed
exceeded the 2.65 patient care hours/day ratio provided by the bill. It also must be recognized
that there are homes with less than a 2.65 ratio that provide an acceptable level of care and
services. The extensive regulatory program for these facilities has no difficulty in detecting
insufficient staff performance.
Supporters/Opponents: No information is available at this time.
Fiscal Information: Whenever minimum standards are established or increased for this
program, there is a direct charge to the Medicaid program which is obligated to pay for required
services.
Administrative Rules Impact: None.
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