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Appendix C: Separate Statement and Responses
Pages 199-204

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From page 199...
... Nevertheless, I feel constrained to comment separately on what was probably the single most contentious issue confronted by the committee, recommendation 6-1, which recommends 24-hour registered nurse (RN) coverage for all nursing homes by the year 2000 along with the appropriation of sufficient funds to pay for this enhanced level of service.
From page 200...
... There was an estimate provided by the nursing home industry that each additional hour of mandated nursing service would result in an increased nursing home cost for Medicare and Medicaid of $3.4 billion per year. One cannot just multiply $3.4 billion per year by the additional 16 hours proposed in recommendation 6-1 to calculate the incremental cost of the proposal above existing expenditures.
From page 201...
... To support recommendation 6-1, it is not enough to recite a relationship between overall staffing intensity and aggregate quality outcomes. More precision is needed, and some mechanism for evaluating the purported benefits is necessary in order to conduct sensible policy discussions and to establish priorities for public spending responsibly.
From page 202...
... The data from nursing facilities showed that some had inadequate numbers of registered nurses, which we considered showed the need for stronger minimum standards. Based on the research findings, some members of the committee supported even stronger minimum mandated staffing levels for registered nurses and other nursing personnel, including nursing assistants.
From page 203...
... Current research data on nursing facilities, like other health services research data, do not have the precision that we would like. However, although we may lament that the real world of nursing facility and hospital care is too complex to calculate the exact cost-benefit in adopting improved staffing standards, we must make our best judgments based on the information available.
From page 204...
... This suggestion is totally unacceptable as a means of providing minimum professional protection and care for very ill and disabled individuals, who frequently have complex nursing and medical care needs, as well as medical emergencies, that require immediate skilled nursing attention. I voted for this recommendation because it was the right thing to do in light of the increasing acuity of care needs in nursing homes, the knowledge that we do have about the relationship of quality and staffing, and my own 30 years of experience in developing, implementing, and evaluating nurse staffing in hospitals.


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