州立退伍军人之家的人员配置趋势：它们是否符合2024年医疗保险和医疗补助服务中心的疗养院人员配置标准？
Trends in Staffing at State Veterans Homes: Do They Meet the 2024 Centers for Medicare & Medicaid Nursing Home Staffing Standards?
作者信息
Yang Annie W, Mukamel Dana B, Pimentel Camilla B, Hartmann Christine W
机构信息
Yale National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; VA Health Services Research and Development, VA Connecticut Healthcare System, West Haven, CT, USA.
Department of Medicine, University of California Irvine, Irvine, CA, USA.
出版信息
J Am Med Dir Assoc. 2025 Sep 14;26(11):105845. doi: 10.1016/j.jamda.2025.105845.
OBJECTIVES
Determine the proportion of Centers for Medicare & Medicaid (CMS)-certified State Veterans Homes that meet the 2024 CMS Minimum Staffing Standards.
DESIGN (INCLUDING INTERVENTION, IF ANY): Longitudinal descriptive analysis.
SETTING AND PARTICIPANTS
115 CMS-certified State Veterans Homes (SVHs).
METHODS
We performed a cross-sectional descriptive analysis using CMS Payroll Based Journal Files from 2017 to 2024. We calculated and graphed average quarterly staffing levels for 4 staffing measures: total nurse hours-per-resident-day (HPRD), registered nurse (RN)-only HPRD, licensed practical nurse (LPN) HPRD, and certified nurse aide (CNA) HPRD. Total nurse HPRD represents the aggregate of RN, LPN, and CNA hours. We compared 2024 quarter 4 (Q4) SVH staffing to the national average. For 2024 Q4, we also determined the proportion of SVHs that met the CMS staffing requirements: (1) >3.48 total nurse HPRD requirement, (2) >0.55 RN-only HPRD, (3) >2.45 CNA HPRD, (4) met all 3 of the previous requirements.
RESULTS
We identified 115 (out of 120) CMS-certified SVHs in the data. Five SVHs did not have data in the Payroll Based Journal. Average quarterly staffing levels were consistently above the national average from 2017-2024. In 2024 Q4, the average total nurse HPRD was 5.07 (SD 0.96), RN-only HPRD 1.15 (SD 0.47), LPN HPRD 0.83 HPRD (SD 0.43), and CNA HPRD 3.09 (SD 0.70). Total nurse HPRD, RN-only HPRD, and CNA HPRD were 33%, 74%, and 37% higher, respectively, than the 2024 national average. Eighty-two percent of SVHs met all 3 of the 2024 CMS staffing requirements.
CONCLUSIONS AND IMPLICATIONS
More than 4 of every 5 SVHs met the 2024 CMS Staffing Standards and sustained staffing levels above the national average from 2017 through 2024. Future studies should explore why staffing levels of SVHs have remained high, including patient and facility characteristics, to offer insights into factors driving higher levels of nursing home staffing.
目标
确定符合2024年医疗保险和医疗补助服务中心（CMS）最低人员配备标准的CMS认证州立退伍军人之家的比例。
设计（包括干预措施，如有）：纵向描述性分析。
设置和参与者
115家CMS认证的州立退伍军人之家（SVH）。
方法
我们使用2017年至2024年的CMS基于工资单的日志文件进行了横断面描述性分析。我们计算并绘制了4项人员配备指标的季度平均人员配备水平：每位居民每天的总护士工时（HPRD）、仅注册护士（RN）的HPRD、执业护士（LPN）的HPRD和认证护理助理（CNA）的HPRD。总护士HPRD代表RN、LPN和CNA工时的总和。我们将2024年第四季度（Q4）SVH的人员配备与全国平均水平进行了比较。对于2024年第四季度，我们还确定了符合CMS人员配备要求的SVH的比例：（1）总护士HPRD要求>3.48，（2）仅RN的HPRD>0.55，（3）CNA的HPRD>2.45，（4）满足前三项要求中的所有三项。
结果
我们在数据中识别出120家CMS认证的SVH中的115家。5家SVH在基于工资单的日志中没有数据。2017年至2024年期间，季度平均人员配备水平一直高于全国平均水平。在2024年第四季度，平均总护士HPRD为5.07（标准差0.96），仅RN的HPRD为1.15（标准差0.47），LPN的HPRD为0.83 HPRD（标准差0.43），CNA的HPRD为3.09（标准差0.70）。总护士HPRD、仅RN的HPRD和CNA的HPRD分别比2024年全国平均水平高33%、74%和37%。82%的SVH满足了2024年CMS的所有三项人员配备要求。
结论和启示
每5家SVH中就有超过4家符合2024年CMS人员配备标准，并且在2017年至2024年期间人员配备水平持续高于全国平均水平。未来的研究应该探讨SVH人员配备水平居高不下的原因，包括患者和设施特征，以便深入了解推动养老院人员配备水平提高的因素。
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