What is staffing?
Staffing is the ratio of care providers to residents. If I told you there was one teacher in a classroom and asked if the children were getting a good education, you would ask, among other things, how many students are there, right?
The staffing ratio is measured per patient day, midnight to midnight. Why? Because more staff is needed during the day shift, when there are multiple meals, various therapies, assisted trips to the bathroom, baths, numerous medication passes, diaper changes, etc. During the night shift, most residents are sleeping.
Let me give you an example. If there are 10 residents in a facility and during a 24-hour period there are 5 staff members who work hour shifts and provide direct care to those residents, then there is a total of 40 hours of care provided. The ratio is expressed as hours per patient day (PPD), so in my example you would divide 40 (the hours of care provided) by 10 (the number of residents) and arrive at PPD staffing ratio of 4.0. This means, in theory, in a 24-hour period each resident should get 4.0 hours of staff time and attention.
Why is staffing important? Numerous studies have proven that staffing is the single most important predictor of patient outcome in a nursing home. Even more important than diagnosis. Consider that for a moment! This means a sick person in a properly staffed nursing home has a better chance for a positive outcome than a well person in an understaffed nursing home. Having done nursing home litigation for the last thirteen years, I can tell you this is absolutely true.
95% of the Elder Abuse cases I file involve understaffing. Staffing is the single largest item on the operating budget of every nursing home. The corporation that runs the nursing home wants to maximize profits, so they start by cutting one nurse, then a Certified Nursing Assistant (CNA), then more staff, and before long the question is simply this: what is the fewest number of people we can possibly employ in this place? This is why most nursing homes have employee turnover of 80% to 90% per year. It is demoralizing to work in a place where, no matter how hard you try, you can’t get all the work done. And they aren’t making crates, they’re (supposed to be) taking care of people.
The standard of care in California is a minimum PPD of 4.1. Unfortunately, because of the incredibly powerful nursing home lobby in Sacramento, the “legal minimum” right now in California is 3.2. This means the State of California will only enforce 3.2; it’s up to us to enforce 4.1. When the 3.2 bill was passed several years ago, it was supposed to go up by .1 per year, but we are still waiting.
