By Steve Moran

Recently I published a three-article series about the proposed staffing mandates for nursing homes. My bottom line was — and remains — that the industry should support staffing minimums done right and reasonably. This means a bunch of things:

  • The minimums need to be just that — minimums — but that if a nursing home is well run, it would mostly operate at above the minimum.
  • They have to take into account the variability in acuity. So for instance, rural nursing homes tend to have residents with less acute needs, and their minimums should be lower.
  • The regulations should not be implemented unless there are really enough people to fill all the positions. While a concern for all, the staffing shortage is a particularly difficult problem for rural operators.
  • There has to be enough money to not just meet minimums but to be able to staff at a level that allows for good care.
  • There needs to me some wiggle room for people trying and doing innovative things that might actually provide better care with lower staffing.

In my mind the biggest reason for supporting staffing minimums is an image issue. What we seem to miss as an industry is that when the industry stands up and says “no minimums,” it makes us look in the public’s eye like operators are greedy and don’t care about residents.

We are all glad for minimum staffing requirements for child daycare centers and the airlines we fly on. We would be distrustful if they said, “Just trust us to do the right thing.” Imagine an airline saying, “Naw we have this great self-flying airplane that can take off and land without human intervention, but just in case, we are going to have one pilot with 250 hours of flight time as a backup to the machine.”  None of us would want that.

The Competing Argument

While at the NIC conference, I got into a friendly but passionate conversation about my thinking with a nursing home operator who did not want his name or company name used. His organizations run great nursing homes that have high star ratings and, more importantly, provide both great care and a great quality of life for residents.

It is impossible for me to imagine they would ever operate below or even close to any kind of government imposed staffing minimum, so this is not about him wanting to skimp on care. They run the kind of nursing home I would want to have my mom in — or even be in if I needed that level of care.

He had four points:

  1. If a nursing home can provide exceptional care at a staffing level below the required minimum level, why should they be forced to hire extra staff?
  2. The problem with minimum staffing levels is that many operators will try to hit that target and then call that good enough regardless of whether residents are actually getting the care they deserve and need.
  3. Higher staffing does not automatically mean better care.
  4. Over time, bad operators will be weeded out. Ultimately if they don’t take good care care of residents and team members, they will and should go out of business.

What do you think?