( bursement rates and the range of acuity...)Policy Changes Have Direct Effect on Nursing Home Care,Health

bursement rates and the range of acuity in patient care.

Medicaid pays for 67 percent of all nursing home residents in the United States, but only covers 51 percent of the $103 billion in total nursing home costs. Medicare covers 12.5 percent of those costs, private insurance pays 7 percent and consumers pay 29.5 percent.

In 2002, the average US nursing home had 15 percent fewer registered nurses per resident than nationally recommended, Harrington said. That recommendation originated in a 2001 study for the Centers for Medicare and Medicaid Services. A report by the Institute of Medicine two years later, titled "Keeping Patients Safe," recommended that nursing homes be required to meet the levels from the 2001 study to maintain patient safety.

As expected, this study found that higher percentages of Medicaid residents correlated to lower total staffing levels, Harrington said. While it also showed that nursing homes, on average, do adjust their registered-nursing levels for the acuity of care needed, most do not increase total staffing for more acutely ill residents, which also could result in inadequate care.

Overall, nursing homes with more Medicaid residents, for-profit nursing homes, and those with a larger number of beds had fewer registered nurses and total nursing staff per patient. Nursing homes in counties with more elderly residents, more women in the workforce, and higher incomes had higher registered-nurse staffing levels.

This study found that nursing homes located in states that had increased their minimum standards for registered nursing hours had higher registered-nurse staffing levels. For example, a 10 percent increase in state minimum staffing standards would result in an increase of 1.66 hours per resident-day (or 16.6 hours for every 100 residents) in actual staffing, if all other factors remain equal, Harrington said.

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