Nursing home staffing loophole increases medical costs for the elderly

A KDI analysis reveals that current laws allow nursing homes to operate without any registered nurses on site, a loophole that could be addressed by increasing the proportion of skilled staff to reduce elderly medical expenditures by 7.7%.

Under current law, nursing homes must deploy at least one nursing staff member for every 25 residents. However, this staff member does not necessarily have to be a "registered nurse." Because the legal regulations group registered nurses and nursing assistants together within the same staffing category, a structural loophole exists that allows nursing homes to operate with zero registered nurses on site.

According to an analysis by KDI, although there is a clear distinction between the roles of registered nurses, who make professional judgments, and nursing assistants, who assist them, current staffing standards fail to reflect this difference in expertise. The current structure, in which nursing assistants make up a high proportion of the nursing staff, directly impacts the quality of care in nursing facilities.

Increasing nurse proportion by 10%p reduces elderly medical costs by 7.7%

KDI analyzed the impact of expanding skilled nursing staff within nursing facilities on the health of resident elderly individuals. The study found that when the proportion of registered nurses among nursing staff increases by 10 percentage points, the number of outpatient visits and hospital stay days for resident elderly individuals decreases. In particular, hospital usage due to bedsores or urinary tract infections—conditions highly sensitive to the quality of nursing and care—decreased significantly.

These changes also have a positive impact on national finances. As skilled registered nurses closely monitor the condition of residents and make professional judgments, the health status of the elderly residents improves. Consequently, an effect of a 7.7% reduction in health insurance medical expenditures for the elderly was confirmed. This suggests that high-quality care within facilities can lead to reduced use of medical services, thereby easing the financial burden on health insurance.

Need for integrated perspective between long-term care insurance and health insurance

To increase the professionalism of nursing facilities, researchers proposed a plan to specify a minimum ratio of registered nurses in the nursing staff deployment standards. For example, a pilot project for professional nursing rooms that set the proportion of registered nurses at 60% or more could serve as a precedent. However, the challenge remains that the long-term care insurance fee system must support the increase in labor costs to allow for the hiring of more registered nurses.

KDI emphasized that the expansion of registered nurses should not be viewed merely as a simple expenditure. While increasing the hiring of registered nurses may act as a cost increase in terms of long-term care insurance, it brings an investment effect in the form of medical cost savings in terms of health insurance finances. Therefore, when designing future policies, the practical effects of expanding nursing staff should be evaluated by considering long-term care insurance and health insurance finances from an integrated perspective.

Source: KDI (YouTube)