All mandated and aspirational goals of a nursing service in an American nursing home (NH) are only achievable through the work of individual nursing staff members working in a coordinated manner supported by the organization context or infrastructure of the NH itself and its controlling operational entity, be that a for-profit or not for profit organization.

While this is a general statement and an obvious one, it is important to remember this as our nation struggles to agree on the government’s proper rule in mandating staffing standards. As summarized in a recent senior care policy briefing, the American HealthCare Association (AHCA), Leading Age, the Texas Health Care Association, and three skilled nursing facilities hope to overturn the Centers for Medicare and Medicaid’s (CMS) recent staffing mandate. They assert that such unattainable standards could “harm nursing home residents.”

This is an absurd statement on its face. In an industry that is for-profit, and its services known to be labor-intensive, it is difficult to understand how residents’ well being is achieved by preventing CMS from requiring a baseline level of staffing where scarcity of human resources is commonplace.

It may be that nursing services themselves, for a variety of reasons that are beyond the focus of this article, have been unable to explain the nature of their work to the public in a way that goes beyond a focus on individual job descriptions and mandated staffing ratios. The work of the nursing service is complex and two-tiered. It includes the direct care of an individual staff member with a resident and the specific way in which this direct care supports and sustains the indirect care infrastructure of the service itself.

The historic emphasis on the primacy of the care plan and care planning have inadvertently contributed to nursing service’s limitations in describing to itself and to the public the work and services that consumers’ tax dollars are supposed to be providing. It is my belief that a clearer understanding of the actual work of nursing staff is a means by which we may better educate the consumer about how essential it is to have a federal mandated staffing standard in American NHs.

For more detail see:
Long Term Care Community Coalition Senior Care Policy Briefing (https://nursinghome411.org/policybriefing)
Dellefield ME., Madrigal C. In Nursing Clinics of North America-Elder Care (2023). Chapter 17, Nursing leadership – transforming the work environment in nursing homes.