nursing home staffing issues - quality of care
Nurses and other health professionals provide care to about 1.6
million nursing home residents in the United States. Many studies
have shown that the number of hours provided by registered nurses
(RNs) to nursing home residents is related to the quality of care
these patients receive. However, a recent study concludes that
nursing home characteristics and geographic location are stronger
predictors of nursing home care deficiencies than staffing hours
and resident characteristics.
The study, which was supported in part by the Agency for
Healthcare Research and Quality (HS07574) and led by Charlene
Harrington, Ph.D., of the University of California, San Francisco,
examined the data reporting system for all U.S. certified nursing
homes to identify deficiencies in nursing home care.
Deficiencies are issued to nursing homes by State licensing and
certification surveyors for different types of care problems. The
researchers studied the association of care deficiency types with
facility staffing hours per resident day, resident
characteristics, facility characteristics, and State. They found
that fewer RN hours and nursing assistant hours were associated
with total deficiencies and quality of care deficiencies. Fewer
nursing assistant staff and other care staff hours were associated
with quality of life deficiencies. Fewer administrative staff
hours were associated with other deficiencies, including
administrative deficiencies. However, staffing hours alone
predicted less than 1 percent of the total variance in
deficiencies.
Together, staffing and resident characteristics only explained
3 percent of the variance in nursing home deficiencies. When
facility characteristics and region were added to the model, the
proportion of variance explained increased to 21 percent. For
instance, facilities that were smaller and nonprofit or
government-owned had fewer deficiencies. Facilities with a higher
percentage of Medicaid residents had more deficiencies. Because
these factors could explain only a small proportion of the
variance in nursing home care deficiencies, the researchers call
for more research on the topic.
See "Nursing home staffing and its relationship to
deficiencies," by Dr. Harrington, David Zimmerman, Ph.D., Sarita
L. Karon, Ph.D., and others, in the September 2000 Journal of
Gerontology: Social Sciences 55(5), pp. S278-S287.
Reprints are available from the AHRQ Publications
Clearinghouse.
These are excerpts from the AHRQ Research Activities,
you can read their full reports at
http://www.ahrq.gov/research/nov00/1100ra18.htm |