Making the Case for Increasing Staffing Numbers Based on Resident Acuity in Nursing Homes: Outlining the Impact of High-Acuity Care Needs on Staffing Requirements

Dear [Administrator/Supervisor],

I am writing to request an increase in staffing numbers at our nursing home based on the acuity of our residents rather than the census number. As you are aware, F725 and F726 of the Federal Code of Regulations require that nursing homes provide sufficient staff to meet the needs of their residents. I strongly believe that increasing staffing numbers based on resident acuity is crucial for providing quality care to our residents and complying with federal regulations.

Resident acuity refers to the level of care required by individual residents. This can include wounds, IV therapy, tube feeding, and other skilled services. Additionally, residents may require assistance with activities of daily living (ADLs) and may be at increased risk for falls and challenging behaviors. Providing care for residents with high acuity levels requires additional staffing resources, as these residents often require more frequent and specialized attention from nursing staff.

Here are some examples of how the acuity of our residents is consuming more time:

• Wound care: X number of residents require daily dressing changes, which take approximately X minutes per resident per day. This adds up to X hours of nursing time per day.
• IV therapy: X number of residents require IV medications or fluids, which require frequent monitoring and adjustments. This requires X hours of nursing time per day.
• Tube feeding: X number of residents require tube feeding, which requires frequent monitoring and adjustments to ensure proper nutrition and hydration. This requires X hours of nursing time per day.
• Skill services: X number of residents require skilled nursing services such as tracheostomy care, central line maintenance, or complex wound care. These services require specialized training and expertise and can consume X hours of nursing time per day.
• ADL dependences: X number of residents require assistance with activities of daily living such as bathing, dressing, and toileting. This requires X hours of nursing assistant time per day.
• Increase in falls: X number of residents are at high risk for falls and require frequent monitoring and interventions to prevent falls. This requires X hours of nursing time per day.
• Behaviors: X number of residents exhibit challenging behaviors such as agitation, aggression, or wandering. These behaviors require frequent monitoring and interventions to ensure the safety of the resident and others. This requires X hours of nursing time per day.

While census numbers are an important consideration when determining staffing levels, they do not fully reflect the needs of our residents. A high census may not necessarily mean that all of our residents have similar acuity levels, and thus may not accurately reflect the staffing needs of the facility. By increasing staffing numbers based on resident acuity, we can ensure that our staff is equipped to meet the needs of all our residents, regardless of their individual care requirements.

Furthermore, increasing staffing numbers based on resident acuity is not only essential for providing quality care to our residents, but it is also a requirement for compliance with federal regulations. The Centers for Medicare and Medicaid Services (CMS) requires nursing homes to provide sufficient staffing to meet the needs of their residents. Failing to do so can result in significant financial penalties and even loss of certification.

In conclusion, I strongly recommend that we increase staffing numbers at our nursing home based on resident acuity. By doing so, we can ensure that our residents receive the highest quality care possible, and that we remain in compliance with federal regulations. Thank you for your consideration of this important matter.

Sincerely,

[Your Name]