Unbiased Analysis of Today's Healthcare Issues

Should there be a mandated nurse/patient ratio in Nursing Home facilities?

Written By: Jason Shafrin - Jul• 17•08

A recent paper by Kitchener et al. (HSR 2008) investigates the actions of one nursing home chain to find how they maximized their profits. The authors find that Sun Healthcare Inc. employed three strategies to maximize shareholder value:

  1. rapid growth through debt-financed mergers;
  2. labor cost constraint through low nurse staffing levels; and
  3. a model of corporate governance that views sanctions for fraud and poor quality as a cost of business.

Should the government impose a minimum nurse/patient ratio in order that quality care continues?

Most libertarians abhor almost any form of regulation, but the case of the nursing homes may be an exception. The “customers” of nursing home care are elderly patients who–by definition–are in some way not able to take care of themselves. Thus, if the patient is treated poorly, it may be nearly impossible for them to change facilities or often it is even difficult for the elderly individual to communicate to their relatives that their care level is poor. The Kitchener paper found that one nursing home chain is sacrificing quality by using low nursing staffing level; should the government mandate a minimum nursing staffing level for nursing homes?

I would argue that they should not. While nurses are of course one of the most–if not the most–important input which affects the quality of nursing home care, regulating inputs is not ideal. This regulation will likely stifle innovation. If new technologies are developed–such as a digital scale monitoring device mentioned in Akshay Kapur’s blog–it may be possible to substitute capital (technology) for labor (nurses) and achieve better medical care for lower costs.

Should nursing homes be exempt from regulation? On this point, I believe that there should be some regulation. The government must continue to monitor nursing home quality and register complaints. Nursing homes with low quality scores or who abuse patients should not receive Medicare or Medicaid patients.

It is important for the government to play a role in helping those who cannot help themselves; yet the government should not mandate how nursing homes should run their business, but instead insure that some minimum quality of care threshold is met.

You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.


  1. Akshay Kapur says:

    Thanks for the link love Jason! I certainly agree that standards and protocols are better solutions than straight-up regulation. I mean, how far have we gotten in health care trying to suggest and authorize quality of care measures rather than just upholding facilities to agreed-upon standards? We need a GAAP for health care.

  2. […] Keeping the faith. Some nursing homes maximize profits by keeping nursing staff levels low and treating sanctions for fraud and poor quality as a cost of doing business. That doesn’t mean we need minimum nurse staffing ratios, though. Take that, ANA! Healthcare Economist. […]