FOOD: It's not uncommon for homes to spend only $2 or $3 per day to feed patients. At the Evergreen Gridley Health Care Center in Northern California, for example, the home spends an average of $1.91 daily per resident, according to a U.S. News analysis of state records. Nursing homes can cut costs with bulk buying, and there is no hard-and-fast rule on how much money is appropriate. Still, Evergreen spends about a dollar a day less than what California spends on food for inmates in state medical prisons. And the amount is less than half what the U.S. Department of Agriculture says is the minimum necessary for a nutritious diet for the elderly. The home's administrator did not return calls.
PAY: Nurse aides, the front-line troops in daily care, typically might earn about $8 an hour for exhausting, unpleasant, and often dangerous work. Some of the lowest pay is in Texas. In 2000, U.S. News found, 78 percent of 1,010 nursing homes in Texas paid average hourly rates at or below $8.20–the federal poverty line for a family of four. Under relentless time pressure, nursing home aides spend hours on their feet; they feed, lift, and clean up after residents often unable to help themselves. Workplace safety statistics show these workers have more than double the national average rates of injury and illness. Not surprisingly, the annual rate of staff turnover at nursing homes routinely tops 100 percent.
STAFFING: U.S. News finds that about 92 of 100 U.S. homes fall short of staffing levels identified in a recent federal study. That project, 12 years in the making, showed that care suffered when nursing time fell below certain levels– including an average of about 40 minutes a day for each patient with registered nurses, and 21/2 hours with nurse aides. – C.H.S.