the quality of a nursing homes staff is one of the biggest predictors in quality of patient care.  An under-staffed nursing home puts patients at risk for developing conditions such as bedsores, improper medication or malnutrition.  An overworked staff may lead to patient neglect.

The Nursing Home Reform Act (NHRA) sets forth minimum staffing levels for registered nurses (RN), licensed practical nurses (LPN), and minimum educational training for nurse's aides (NA).  The requirements are:

• A registered nurse must be the director of nursing
• A registered nurse must be on duty at least 8 hours per day, 7 days per week
• A licensed nurse must be on duty the rest of the time.
• Nurse's aides must have at least 75 hours of training

States may legislate as to more intensive staffing requirements.  In addition to the above requirements the NHRA requires nursing homes "to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychological well-being to each resident."  Until the government legislates to provide specific nursing ratios, nursing home owners and administrators have little incentive to provide more than a bare bones staffing of their facilities.

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