1. Safe Staffing in Skilled Nursing and Long Term Care Facilities By: Renea Clark, RN March 4, 2015 Western Washington University RN-BSN Program

2. Current WA Law for SNF/LTC: Enough nursing and support staff to “maintain the highest practicable physical, mental and psychosocial well-being, self-care and independence in accordance with his or her comprehensive assessment and plan of care. ( WAC 388-97-1060)”

3. 97% of SNFs are understaffed (Centers for Medicare & Medicaid Services)

4. Quality

5. Hospital Re-admissions 25% of pt’s discharged to SNF are re-admitted within 30 days Costing approximately $4,000,000,000.00 annually 78% are avoidable Urinary tract infections (UTI) Congestive heart failure complications Respiratory infection Sepsis Electrolyte imbalances

6. Benefit of Increased Nursing Care Increased minutes of direct nursing care saved $319,000.00 per 100 bed SNF overall. (Horn, 2008). By reducing UTI’s, Pressure ulcer formation, and hospitalization

7. High Staff Turn Over Rates Studies show that high patient loads increase staff turnover turnover rates in the LTC range from 55-75% The average cost of training a new employee is $2500. 00 (Tilden, Thompson, Gajewski, & Bott, 2012).

8. Why care… “Nurse staffing fits squarely in the realm of better care, better health, and lower costs. Nurse staffing is an evidence-based way to improve quality of care and prevent adverse events… which are costly (Weston, Brewer, & Paterson, 2012).”

9. Recommendation Increase nursing staff in LTC/SNF Change the law to reflect current acute care law Safe staffing committee for each facility made up of 50% direct care staff

10. References Horn, S. D. (2008). The Business Case for Nursing in Long-Term Care. Policy, Politics, & Nursing Practice, 9(2), 88–93. doi:10.1177/1527154408320420 Mor, V., Intrator, O., Feng, Z., & Grabowski, D. C. (2010). The Revolving Door Of Rehospitalization From Skilled Nursing Facilities. Health Affairs, 29(1), 57–64. doi:10.1377/hlthaff.2009.0629 Tilden, V., P., Thompson, S., A., Gajewski, B., J., & Bott, M., J. (2012). End-of-Life Care in Nursing Homes: The High Cost of Staff Turnover. Nursing Economic$, 30(3), 163–166. Weston, M., J., Brewer, K., C., & Peterson, C., A. (2012). ANA Principles: The Framework For Nurse Staffing to Positively Impact Outcomes. Nursing Economic$, 30(5), 247–252.