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Federal health officials have concluded that most nursing homes are understaffed to the point that patients may be endangered. For the first time, the government is recommending strict new rules that would require thousands of the homes to hire more nurses and health aides.
In a report to Congress based on eight years of exhaustive research, the Clinton administration says that understaffing has contributed to an increase in the incidence of severe bedsores, malnutrition and abnormal weight loss among nursing home residents. Many of the patients end up hospitalized for life-threatening infections, dehydration, congestive heart failure and other problems that could probably have been prevented if the homes had more employees, the report says.
The government emphasized that the proposed levels of staff were not the optimal levels, but the minimum needed to prevent patients from being exposed to ``a substantially increased risk'' of poor-quality care.
``More than half of the nation's nursing homes don't meet a minimum benchmark for staffing,'' Mr. Grassley said. ``That means residents don't get fed enough. They don't get turned to prevent bedsores. They end up in the hospital much more often than they should.''
The report found that nursing homes with low staffing levels tended to have large numbers of residents with nutrition problems. Many frail elderly patients need help with meals but do not receive it, and their health declines, the study said.
When employees are in short supply, they often prod patients to eat faster, forcing ''huge spoonfuls of food into their mouths,'' so the patients cough and choke, the report said.
To prevent severe bedsores, also known as pressure ulcers, patients must be turned or moved every two hours, the report said, but this is unlikely to occur in homes with low numbers of nurses' aides. The sores can become infected and damage underlying muscle and bone.
The General Accounting Office, an investigative arm of Congress, said last year that more than one-fourth of nursing homes had deficiencies that ``caused actual harm to residents or placed them at risk of death or serious injury.''
In 1999, the Clinton administration gave inspectors new guidance on how to determine if a home had sufficient nursing staff to meet the residents' needs. But even with this guidance, the report said, there is ''no evidence'' that inspectors can actually determine whether homes comply with the general federal requirement to have sufficient staff.