Inadequate nurse staffing was a critical problem in nursing homes in 1975. The Department of Health, Education and Welfare was already considering mandatory nurse-to-resident staffing ratios to ensure that Medicare and Medicaid beneficiaries got adequate care. And understaffing has been a critical problem in every year since. It doesn’t matter whether the economy is good or bad or the unemployment rate is high or low. It doesn’t matter whether reimbursement rates are too low – as they are in some states – or exorbitant, as they were under Medicare through much of the 90s. Understaffing is always a problem.

Inadequate staffing is a chronic problem that will not be solved by quick fixes – such as CMS’s recent proposed regulation to allow nursing homes to use minimally trained and poorly supervised “feeding assistants” to help residents who are too frail to eat without assistance. It will not be solved by increasing Medicare or Medicaid reimbursement without holding providers accountable for ensuring that they staff their facilities adequately. Understaffing is a problem that calls for a permanent solution – and as soon as possible.

Fortunately, we have seen some progress since 1975: Today, thanks to Charlene Harrington, Jack Schnelle, Andy Kramer at the University of Colorado, and others, we know how many licensed nurses and nursing assistants it takes to care for a nursing home resident. The findings from the two major studies in the report to Congress, the years of research and analysis that went into developing the standards NCCNHR members endorsed in 1998 – all have been consistent in their findings that the typical nursing home resident needs more than four hours of direct care a day from professional nurses and nursing assistants.

We have the research and we know the solution. We must therefore move forward with a serious debate about how we will achieve the outcome – for we surely know that the nursing home horror stories will continue unless we do something. Fifty-two percent of nursing homes are critically, dangerously understaffed. Most of the rest can’t give good care. We must do something.

Rep. Waxman will soon introduce a bill that would implement staffing standards. We strongly support his efforts to provide the legislative vehicle for this debate.

NCCNHR believes that minimum nurse staffing ratios will become law as more and more Americans experience the pain of a loved one’s unnecessary suffering in an understaffed nursing facility. States – such as Florida – are already showing that these staffing levels can be implemented .

There is a tremendous public will to see it happen. At a press conference this morning, NCCNHR presented Congress with the names of almost 100,000 voters in 49 states who signed a petition saying that unnecessary suffering, illness and death caused by understaffing must stop. These voters support mandatory staffing standards.

Two of the family members who supported our petition drive are in the room today and would be glad to take your questions – Nadene Mitcham of Michigan and Belinda Clay of Florida.

Both of these women readjusted their personal lives so they could visit their mothers in their nursing homes every day to make sure they got good care – and to provide much of it themselves, because the nursing homes were understaffed. Nadene’s mother is no longer living, but Nadene continues her visits to support other residents. Belinda continues to care for her mother, although she has been able to go back to work part time because Florida’s mandatory staffing law has improved the care. Unfortunately, most residents do not have immediate families who can make these kinds of commitments – many have outlived their families or their children live in other states. They depend on us to assure good care.

So our petition drive resonated strongly with the American public. Many family members and also nursing home workers wrote us notes saying how strongly they felt about the effort:

From a local ombudsman in Colorado: “You can’t expect one nurse to handle 30 to 40 residents during an eight-hour shift. The situation is beyond critical!”

A Florida family member: “My father was in a nursing home and broke his hip due to lack of supervision. More nurses and CNAs might have saved him the injury.”

From Georgia:  “Please add my name to your petition. It seems the only way to help our loved ones and future nursing home residents is to change the laws. I’d love to help!”

From Illinois: “Please add my name to your petition for more nurses in nursing homes. I have a mother with Alzheimer’s and I’m sure I will face the nursing home decision in the near future. I want her to have a safe environment!”

From Kentucky: “I am currently a CNA. I would like to have my name added to the petition for staffing regulations. I go to different nursing homes to work, and in many of them 20 to 30 residents [per CNA] is the ‘norm.’ I am appalled at the care these residents get and I want to help in any way I can.”

From Oklahoma: “My grandmother died almost two years ago of neglect in the nursing home. Her bedsores turned into gangrene.”

From Tennessee: “My grandmother was in an understaffed nursing home before she died. Please add my name to your petition.”

From West Virginia: “I have worked as a nursing assistant in several different nursing homes. We have always been short of staff. When we are short, it will be one aide to 27-29 residents. To bathe, feed, change and turn. We work 12-hour shifts. How much time does each resident get for quality care? I am there for the residents, and it just isn’t fair to me or them. Tell what can be done to change things.”