Nursing Home Staffing and Training Recommendations for Promoting Older Adults’ Quality of Care and Life: Part 2. Increasing Nurse Staffing and Training (original) (raw)
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Research in Gerontological Nursing, 2008
Caught between the inability or unwillingness of nursing home corporations and owners to redistribute revenue 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 staff. Still, policy makers and nursing home owners have failed to take needed action. In the first article of this two-part series, major deficits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home staffing and the quality of care and life of residents is summarized.
Journal of Gerontological Nursing, 2012
The purpose of this study was to complete an integrated literature review of the relationship between staffing and quality outcomes in nursing homes. The majority of the reviewed studies showed better outcomes with higher nursing staff but depended heavily on cross-sectional observational studies and failed to differentiate RNs from other nursing staff. A total of 28 articles relating nurse staffing and quality outcomes were systematically reviewed and synthesized. However, each study examined different aspects of staffing and different resident or organizational outcomes, making determination of appropriate staffing levels difficult. The reviewed studies have not clearly defined the relationship between differing levels of nurse-staffing skill mix and specific structure, process, outcome, and composite indicators of quality. The inconsistent findings suggest that further research is needed in this area.
Medical Care in the Nursing Home
American Journal of Nursing, 1998
Recommendation 1. Effective leadership structures are established, that where possible, include an expert physician (medical director), and an expert registered nurse (nursing director) and skilled administrator.
Caregiver Staffing in Nursing Homes and Their Influence on Quality of Care
Medical Care, 2011
Background: There is inconclusive evidence that nursing home caregiver staffing characteristics influence quality of care. In this research, the relationship of caregiver staffing levels, turnover, agency use, and professional staff mix with quality is further examined using a longitudinal analysis to overcome weaknesses of earlier research. Methods: The data used came from a survey of nursing home administrators, Nursing Home Compare, the Online Survey Certification and Reporting data, and the Area Resource File. The staffing variables of Registered Nurses, Licensed Practical Nurses, and Nurse Aides were measured quarterly from 2003 through 2007, and came from 2839 facilities. Generalized method of moments estimation was used to examine the effects of changes in staffing characteristics on changes in 4 quality measures (physical restraint use, catheter use, pain management, and pressure sores). Results: Regression analyses show a robust association between the staffing characteristic variables and quality indicators. A change to more favorable staffing is generally associated with a change to better quality. Conclusions: With longitudinal information and quarterly staffing information, we are able to show that for many nursing homes improving staffing characteristics will improve quality of care.
The Gerontologist, 2007
Purpose: Residential care/assisted living facilities have become an alternative to nursing homes for many individuals, yet little information exists about staffing in these settings and the effect of staffing. This study analyzed the intensity and skill mix of nursing staff using data from a four-state study, and their relationship to outcomes. Design and Methods: We obtained longitudinal data for 1,894 residents of 170 residential care/assisted living facilities participating in the Collaborative Studies of Long-Term Care. Descriptive statistics assessed the levels of direct care staff (registered nurse, licensed practical nurse, personal care aide). Regression analyses evaluated the relationship between two staffing measures (intensity measured as care hours per resident and skill mix measured as the percentage of total care hours by licensed nurses), facility characteristics, and four health outcomes (mortality, nursing home transfer, hospitalization, and incident morbidity). Results: Care hours per resident decreased with facility size (economies of scale) only for very small facilities and increased with dementia prevalence (case-mix effect). Licensed staff accounted for a greater proportion of total hours in nonprofit settings. Health outcomes did not vary by total care hours per resident, but hospitalization rates were significantly lower in facilities with higher proportions of skilled staff hours; this effect was stronger as dementia case mix increased. Implications: Current staffing levels for the outcomes analyzed meet most residents' needs. Reduced hospitalization in relation to greater use of licensed staff suggests that increased use of these workers might result in reductions in acute care expenditures.
Further Examination of the Influence of Caregiver Staffing Levels on Nursing Home Quality
The Gerontologist, 2008
Purpose: Weak empirical evidence exists showing that nursing home staffing levels influence quality of care. We propose that weak findings have resulted in many prior analyses because research models have underspecified the labor composition needed to influence care processes that, in turn, influence quality of care. In this analysis, we specified the nursing home labor composition by using staff stability, use of agency staff, and professional staff mix, in addition to staffing levels. Design and Methods: Data used in this investigation came from surveys of nursing home administrators (N = 6,005); Nursing Home Compare; the Online Survey, Certification and Reporting data; and the Area Resource File. Staffing characteristics, quality indicators, facility, and market information from these data sources were all measured in 2004. Results: The regression analyses showed that staffing levels alone were weakly associated with the six quality measures examined. However, when the regression models were more fully specified (by including agency staff, stability, and professional staff mix), staffing levels were generally associated with the quality measures (i.e., 15 of the 18 staffing coefficients were significant). Implications: Simply adding more staff may be a necessary but not sufficient means of improving nursing home quality. Some accounting for agency staff, stability, and professional staff mix is also needed.
Geriatrics
Background: Little documentation exists on relationships between long-term residential care facilities (LTRCFs), staff working conditions and residents’ quality of care (QoC). Supporting evidence is weak because most studies examining this employ cross-sectional designs. Methods: Systematic searches of twelve bibliographic databases sought experimental and longitudinal studies, published up to May 2021, focusing on LTRCF nursing staff’s working conditions and the QoC they provided to older adults. Results: Of the 3577 articles identified, 159 were read entirely, and 11 were retained for inclusion. Higher nursing staff hours worked per resident per day (HPRD) were associated with significant reductions in pressure sores and urinary tract infections. Overall staff qualification levels and numbers of RNs had significant positive influences on QoC. Conclusions: To the best of our knowledge, this systematic review is the first to combine cohort studies with a quasi-experimental study to ...