Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality.
Over 20 years ago, the Australian Liberal/National Party Federal Opposition had a set of policies with which it hoped to persuade the Australian people to return it to government in the election due in 1996. This particular collection of proposed initiatives was called “The things that matter”. When the then leader of the opposition, Alexander Downer (later Australia’s Foreign Minister 1996-2007 and now Australian High Commissioner in London), launched the Opposition’s policy on family violence (the Coalition parties, like their Labor opponents, were and are against it in principle), his introductory line was: “From the things that matter to the things that batter”. Not long afterwards he lost his job as Opposition Leader, his engagement with what was and is a serious and troubling issue having been deemed too glib by half by the shapers of public opinion.