123 Research in Gerontological Nursing • Vol. 1, No. 2, 2008 Nursing Home Stafng and Training Recommendations for Promoting Older Adults’ Quality of Care and Life Part 1. Deficits in the Quality of Care Due to Understaffing and Undertraining Meridean L. Maas, PhD, RN, FAAN; Janet P. Specht, PhD, RN, FAAN; Kathleen C. Buckwalter, PhD, RN, FAAN; Josephine Gittler, JD; and Kate Bechen, JD, MPH ABSTRACT Caught between the inability or unwillingness of nursing home corporations and owners to redistribute rev- enue and the reluctance of federal and state agencies to increase payments to nursing homes, the nation’s most vulnerable older adults are not receiving the care they deserve. Widespread recognition of substandard care and quality of life of older adults in nursing homes has existed for decades. In addition, there is substantial evidence that poor quality of care is related to inadequate numbers and training of nursing staf. Still, policy makers and nursing home owners have failed to take needed action. In the frst article of this two-part series, major defcits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home stafng and the quality of care and life of residents is summarized. Dr. Maas is Professor Emerita of Nursing and Co-Director, The John A. Hartford Center of Geriatric Nursing Excellence, Dr. Specht is Associate Professor of Nursing and Practice Director, The John A. Hartford Center of Geriatric Nursing Excellence, Dr. Buckwalter is Sally Mathis Professor of Gerontological Nursing Research and Director, The John A. Hartford Center of Geriatric Nursing Excellence, The University of Iowa College of Nurs- ing, Dr. Gittler is Wiley B. Rutledge Professor of Law, Professor of Health Management and Policy, and Policy Director, The John A. Hartford Center of Geriatric Nursing Excellence, and Dr. Bechen is Research Assistant, The University of Iowa, Iowa City, Iowa. This research was funded by the Nellie Ball Trust Research Fund, Iowa State Bank and Trust Company, Trustee, and The John A. Hartford Center of Geriatric Nursing Excellence, The University of Iowa College of Nursing. Address correspondence to Meridean L. Maas, PhD, RN, FAAN, Professor Emerita of Nursing, Co-Director, The John A. Hartford Center of Geriatric Nursing Excellence, The University of Iowa College of Nursing, 456 NB, Iowa City, IA 52242; e-mail: meridean-maas@uiowa.edu. Te probability that a person in the United States will reside in a nursing home at some time prior to death is 43% to 56% (Spillman, Liu, & McGilliard, 2002). Te likelihood of having a parent, older relative, or friend in a nursing home at some point is even greater. Tis means more than one half of the population has a vested interest in the qual- ity of care of older adults in nursing homes, which have faced serious problems for many years. In 1999, the U.S. Ofce of the Inspector General agreed that quality defcits are common in many of the nation’s nursing homes (U.S. General Accounting Ofce, 1999). Although state and federal regulations have steadily in- creased in response to poor quality, quality of care in nurs- ing homes remains defcient. Tis is despite mounting consensus based on reported studies that inadequate staf- ing is a chief reason for the intractability of poor quality in nursing homes. Too few nursing staf, especially RNs and certifed nursing assistants (CNAs), are employed in the nation’s nursing homes. Although nursing staf comprises 60% of all staf in nursing homes, substandard training in Literature Review