THE AMERICAN GERIATRICS SOCIETY/AMERICAN ASSOCIATION FOR GERIATRIC PSYCHIATRY MENTAL HEALTH IN NURSING HOMES

To the Editor: The National Citizens’ Coalition for Nursing Home Reform (NCCNHR) had the privilege of serving on the expert panel involved in the development of two articles found elsewhere in this issue of the Journal of the American Geriatrics Society: the American Geriatrics Society/American Association for Geriatric Psychiatry Recommendations for Policies in Support of Quality Mental Health Care in U.S. Nursing Homes and the Consensus Statement on Improving the Quality of Mental Health Care in U.S. Nursing Homes: Management of Depression and Behavioral Symptoms Associated with Dementia. We are pleased to endorse the consensus statement but regret that the policy recommendations do not call for prompt implementation of nurse staffing ratios that experts consistently identify as necessary to provide for the basic care of nursing home residents. Although additional research might find an ideal ratio for caring for those with dementia and mental illnesses, we know from existing research that minimum needs cannot be met without at least 4.1 hours of direct care a day. Fewer than 10% of nursing homes meet this standard, and more than half fall so far below it that residents are in jeopardy. NCCNHR advocates a minimum standard of 4.13 hoursFa level validated by a consensus panel of the Hartford Center for Geriatric Nursing, a congressional study of nurse staffing ratios released by the Department of Health and Human Services last year, and other research. As the policy statement says so well, ‘‘Highquality mental health care in nursing homes is possible only when the level of nurse staffing is adequate to provide the necessary amount of direct care.’’