Critical Access Hospital-NHPPD

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    In my CAH right now, I have 18 unskilled, custodial-type patients who reside here (according to the state they are categorized as unskilled swing patients but they are basically nursing home pts). In addition, right now we have 4 skilled swing patients. We are staffed with an LPN (primarily responsible for the 18 unskilled swings and 2 of the skilled swings) 3 CNAs during the day, 2 at night and an RN/Charge nurse who is caring for the other 2 skilled swing patients and covers the ER (average 1 patient/day).

    Staffing in our CAH right now figures out to be 4.6 NHPPD for this mixture of unskilled and skilled swing patients. I'd like opinions if this is too few nursing hours? How about if we admit an acute patient-the ones we admit are mostly 24 hour observation patients. Anybody else deal with figuring the appropriate number of NHPPD in a setting where the patient-type is mixed? I'd like to know how you do it?

    Thanks
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