Center for Health Policy and Evaluation in Long-Term Care, American Health Care Association/National Center for Assisted Living, Washington, District of Columbia, USA.
Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
J Am Geriatr Soc. 2022 Apr;70(4):1198-1207. doi: 10.1111/jgs.17678. Epub 2022 Feb 3.
Federal minimum nurse staffing levels for skilled nursing facilities (SNFs) were proposed in 2019 U.S. Congressional bills. We estimated costs and personnel needed to meet the proposed staffing levels, and examined characteristics of SNFs not meeting these thresholds.
This was a cross-sectional analysis of 2019Q4 payroll data, the Hospital Wage Index, and other administrative data for 14,964 Medicare and Medicaid-certified SNFs. We examined characteristics of SNFs not meeting proposed minimum thresholds: 4.1 total nursing hours per resident day (HPRD); 0.75 registered nurse (RN) HPRD; 0.54 licensed practical nurse (LPN) HPRD; and 2.81 certified nursing assistant (CNA) HPRD. For SNFs falling below the thresholds, we calculated the additional HPRD needed, along with the associated full-time equivalent (FTE) personnel and salary costs.
In 2019, 25.0% of SNFs met the minimum 4.1 total nursing HPRD, while 31.0%, 84.5%, and 10.7% met the RN, LPN, and CNA thresholds, respectively. Only 5.0% met all four categories. In adjusted analyses, factors most strongly associated with SNFs not meeting the proposed minimums were: higher Medicaid census, larger bed size, for-profit ownership, higher county SNF competition; and, for RNs specifically, higher community poverty and lower Medicare census. Rural SNFs were less likely to meet all categories and this was explained primarily by county SNF competition. We estimate that achieving the proposed federal minimums across SNFs nationwide would require an estimated additional 35,804 RN, 3509 LPN, and 116,929 CNA FTEs at $7.25 billion annually in salary costs based on current wage rates and prepandemic resident census levels.
Achieving proposed minimum nurse staffing levels in SNFs will require substantial financial investment in the workforce and targeted support of low-resource facilities. Extensive recruitment and retention efforts are needed to overcome supply constraints, particularly in the aftermath of the COVID-19 pandemic.
2019 年美国国会提出了联邦最低护士人员配置标准，适用于熟练护理设施（SNF）。我们估计了满足拟议人员配置标准所需的成本和人员，并研究了不符合这些标准的 SNF 的特征。
这是对 2019 年第四季度工资单数据、医院工资指数和其他行政数据进行的横断面分析，涉及 14964 家经医疗保险和医疗补助认证的 SNF。我们研究了不符合拟议最低标准的 SNF 的特征：每位居民每天 4.1 小时的总护理时间（HPRD）；0.75 名注册护士（RN）HPRD；0.54 名持照实习护士（LPN）HPRD；以及 2.81 名认证护理助理（CNA）HPRD。对于低于这些阈值的 SNF，我们计算了所需的额外 HPRD，以及相关的全职等效（FTE）人员和薪资成本。
2019 年，25.0%的 SNF 达到了最低的 4.1 小时总护理 HPRD，而 31.0%、84.5%和 10.7%分别达到了 RN、LPN 和 CNA 的阈值。只有 5.0%的 SNF 符合所有四个类别。在调整后的分析中，与 SNF 不符合拟议最低标准最相关的因素是：较高的医疗补助普查、较大的床位规模、营利性所有权、较高的县 SNF 竞争；对于 RN 来说，具体而言，社区贫困程度较高和医疗保险普查较低。农村 SNF 更不可能满足所有类别，这主要是由于县 SNF 竞争造成的。我们估计，在全国范围内实现联邦最低标准将需要额外增加 35804 名 RN、3509 名 LPN 和 116929 名 CNA FTE，每年薪资成本为 72.5 亿美元，基于当前工资率和大流行前居民普查水平。
要在 SNF 中达到拟议的最低护士人员配置标准，需要在劳动力方面进行大量的财政投资，并为资源有限的设施提供有针对性的支持。需要进行广泛的招聘和留用工作，以克服供应方面的限制，特别是在 COVID-19 大流行之后。
