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Nursing homes need help

Facilities full but have too few workers, federal report says

By Robert Pear

New York Times News Service

WASHINGTON -- More than 90 percent of the United States' nursing homes have too few workers to take proper care of patients, a new federal study has found.

But the Bush administration, citing the costs involved, says it has no plans to set minimum staffing levels for nursing homes, hoping instead that the problem will be resolved through market forces and more efficient use of existing nurses and nurse's aides.

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The report, ordered by Congress and prepared by the Department of Health and Human Services, concludes that "it is not currently feasible" for the government to require that homes achieve a minimum ratio of nursing staff to patients, as many experts have recommended, largely because of cost. It would take another $7.6 billion a year, an 8 percent increase from current spending, to reach adequate staffing levels, the report says.

Instead of imposing new rules, the Bush administration said, it wants to publish data on the number of workers at each nursing home, in the hope that "nurse staffing levels may simply increase due to the market demand created by an informed public."

Also, the administration said, it will encourage nursing homes to adopt better management techniques, so nurse's aides can achieve "high productivity."

The report found "strong and compelling" evidence that nursing homes with a low ratio of nursing personnel to patients were more likely to provide substandard care. Patients in these homes were more likely to suffer from bedsores, malnutrition, weight loss, dehydration, pneumonia and serious blood-borne infections, the report said.

In most nursing homes, the report said, a patient needs an average of 4.1 hours of care each day, 2.8 hours from nurse's aides and 1.3 hours from registered nurses or licensed practical nurses.

Dr. John F. Schnelle, a co-author of the report, said the recommendations would require homes to have one nurse's aide for every five or six residents from 7 a.m. to 11 p.m. Currently, he said, it is common for nursing homes to have one aide for every eight to 14 residents.

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