According to the CDC, 1.4 million people live in nursing home care facilities as of 2013. With elderly population rising, this number is increasing and poses new health care concerns. Although Medicare/Medicaid federally regulate staffing standards of certified nursing homes, many reports still quote insufficient staff-to-resident ratios (Castle 2008). Inadequate staffing is associated with poor quality of care and neglect (Simmons 2012). This becomes a major concern within the United States healthcare system. There are significant correlations regarding staff-to-resident ratios and overall quality of life beyond medical measurements.

The federal standards for nursing staff in nursing homes within the United States are minimal compared to developed countries throughout the world. Even with nominal standards, nursing home facilities in our country are functioning below recommended levels of staff-to-resident ratios, measured in hours per resident day (HPRD) (Harrington 2008). Because of lack of proficient performance within these long term care facilities, more data and research should be conducted to ensure each nursing home is being held accountable to maintain the recommended staffing level. However, looking at research and data collection which has been conducted, it poses the question as to whether standards need to be increased not just at the state level, but federally.

Increasing standards would increase the access of necessary care of nursing home residents. Concerns have been raised within current nursing homes about the capability of staff to meet multifaceted needs of residents (McCloskey 2015). By increasing nursing staff throughout each shift, each care provider can have the opportunity to attend to each resident when needed. This takes away reoccurring issues of neglect to immediate care of one resident while vital care is being provided to another.

It is obvious staffing alone does not guarantee a better quality of care, but studies show positive relationships between total nursing staff ratios and quality of care provided. A high ratio of nursing staff-to-residents was connected to overall positive progression in mood, social engagement, cognitive performance, and activities of daily living (Reid 2003). These indicators of quality also correlate to reducing agitation among residents. Reducing this negative behavior results in a more positive workplace, increasing the quality of life for residents and the staff employed.

Continual exposure to resident behavior majorly impacts nursing staff performance as well. Nursing home residents, once admitted, often find themselves there for the rest of their lives. Throughout this time, continual relationships are built between residents and the nursing staff, which assist in determining overall quality of life. A stable nursing staff is shown to maintain dignity among nursing home residents, positively influencing personal view of quality of care (Hyun Shin 2014).

However, to maintain a stable nursing staff, long term care facilities have to fight the high turnover rates among licensed nursing professionals. These jobs are often associated with low job satisfaction, lack of empowerment, emotional exhaustion, inadequate administration and resources, and staffing limitations (McGilton 2014). Because of these daily demands, nursing staff face continuous conflicts as they attempt to balance their workload. Nurses continually report poor work conditions prevent them from engaging in proper care because they are expected to resolve a multitude of concerns. Certain aspects of care get disregarded if they do not appear as vital such as toileting, repositioning, feeding, and ambulating. When tasks are not completed at ideal times, additional stress impacts staff leading to a decrease in the quality of care for each individual. In facilities with a higher staff-to-resident ratio, these features of care are provided frequently, improving quality measures while also increasing desire to continue their occupation (Simmons 2012).

If adding staff is the simple fix, it would be assumed this problem could be eliminated. Yet, finances and cost play a high priority in every healthcare decision. Increasing staff-to-resident ratio would result in more employees receiving hourly paychecks. However, looking at overall employment at nursing homes, there are opportunities to properly delegate tasks to other positions to relieve stress among nursing staff. Resident care is only one component of the work done at facilities. Other areas such as social activities, physical exercise, religious services, and dinning play major roles in quality care. A study was conducted to observe time spent by nursing staff showing it is possible a nursing home can delegate less skilled tasks to less expensive workers to eliminate overload on nursing staff.

Understanding how nursing staff and care providers spend their time may help unveil opportunities to improve inefficiencies within nursing home setting, improving overall access, costs, and quality of life.


Castle, N.G. (2008). Nursing home caregiver staffing levels and quality of care. Journal of Applied Gerontology, 27(4), 375-405

Centers for Disease Control and Prevention. (2015) Nursing Home Care. In Long Term Care. Retrieved from:

Harrington, C., Choiniere, J., Goldmann, M., et al. (2012). Nursing home staffing standards and staffing levels in six countries. Journal of Nursing Scholarship, 44(1), 88-98. doi: 10.1111/j.1547-5069.2011.01430.x

Hyun Shin, J., Park, T., Huh, I. (2014). Nursing staff and quality of life in western New York nursing homes. Western Journal of Nursing Research, 36(6), 788-805. doi: 10.1177/0193945913511154

McCloskey, R., Donovan, C., Stewart, C., Donovan, A. (2015). How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: an observational study. International Journal of Nursing Studies, 52, 1475-1483.

McGilton, K.S., Boscart, V. M., Brown, M., Bowers, B. (2014). Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff. International Journal of Nursing Studies, 51, 917-926.

Reid, C., Chappell, N. (2003). Staff ratios and resident outcomes in special care units: do activity aides make a difference? Journal of Applied Gerontological Society, 22(1), 89-103. doi: 10.1177/073346480225004

Shippee, T. P., Henning-Smith, C., Kane, R. L., Lewis, T. (2013). Resident and facility level predictors of quality of life in long term care. The Gerontological Society of America, 55(4), 643-655. doi:10.1093/geront/gnt148

Simmons, S.F., Durkin, D.W., Rahman, A.N., et al. (2012). Resident characteristics related to the lack of morning care provision in long-term care. The Gerontologist, 53, 151-161. doi:10.1093/geront/gns065



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