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from Doug Mann's blog
2 Sept 2005 With current staffing patterns reported by the Star-Tribune, it is clear that the Vets Home, providing less than 0.3
hours of direct nursing care per resident day, is in violation of MN health Department regulations. No MN nursing home may
legally provide less than 2 hours of direct nursing care per resident day, according to a federal HHS report dated November
2003.
However, the defacto minimum has been 0.95 hours per resident day (hprd). I filed, and attempted to file complaints
with the Health Department about understaffing at nursing homes during the 1990s. [When seeking information about minimum
staffing requirements] I was always told that nursing homes are not considered "understaffed" on the basis of staffing patterns
alone unless nurse aide staffing levels fell below 0.95 hours per resident day.
If the average level of direct care
required by Vets Home residents is comparable to that of the average MN nursing home, Vets Home would have to increase the
number of hours worked by nurse aides 10 fold in order to comply with MN Department of Health regulations. (I would be surprised
if any MN nursing home is in compliance with minimum staffing rules.)
According to a federal HHS report dated November
2003, MN Health Department regulations require "an average nursing home" to provide a minimum of 3.0 hours of direct care
per resident in a 24 hour period. The absolute minimum requirement is 2.0 hours per resident day or 0.95 hours per **standardized
resident day,** whichever is greater [presumably in facilities licensed to provide "skilled care"], according to the report
cited below.
Federal HHS report:
State Experiences with Minimum Nursing Staff Ratios for Nursing Facilities: Findings
from Case Studies of Eight States
Jane Tilly, Dr.P.H., Kirsten Black, M.P.P., and Barbara Ormond, Ph.D.
The Urban
Institute
Jennie Harvell
U.S. Department of Health and Human Services
November 2003
http://aspe.hhs.gov/daltcp/reports/8state.htm#append4MN
"Before 2001, three nursing staff standards applied to nursing homes in Minnesota. Since the 1970s, the state has
required that facilities supply 2.0 hprd. In 1983, the state's move to case-mix reimbursement for nursing homes was accompanied
by a regulatory change requiring 0.95 hours per standardized resident day (hpsrd);4 this new standard was designed to take
into account residents' case mix. Facilities had to meet 2.0 hprd or 0.95 hpsrd, which ever was greater. Implementation of
the 0.95 hpsrd requirement and reimbursement system occurred in 1985. The third set of requirements is the federal and state
standards requiring sufficient staffing to meet residents' needs...
"The state determined whether a facility met the
0.95 hpsrd by using a complex series of calculations that took into account individual residents' case mix, the number of
residents in a facility by case-mix class, and the number of productive hours of nursing care each facility provided. A provider
association stated, but state officials did not confirm, that the average facility provided 1.2 hpsrd, which translated to
about 3.0 direct care hours per resident day. Waivers of the state staffing ratios were not permitted because the ratios were
considered a minimum
"The state eliminated the 0.95 hpsrd in 2001 and retained the 2.0 hprd, as it moved to a new
case-mix reimbursement system with 34 case-mix levels. The state made this move because providers complained about having
to do two assessments--one for the old case-mix system and the MDS, which is required by federal rules..."
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