Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality

Abstract

Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

Shortages of Staff in Nursing Homes During the COVID-19 Pandemic: What are the Driving Factors?

“…Adequate staffing levels are required to provide high-quality care to residents. 7,12 A recent article reported that higher RN staffing levels before the pandemic was associated with fewer COVID-19 cases in a sample of Connecticut NHs. 35 A major finding of our study is that staff shortages were associated with COVID-19erelated factors.…”

“…As of June 15, 2020, CMS published data of the weeks ending on May 24 and 31, 2020 for each certified NH and conducted the quality check of the data. 3 Of the 15,451 NHs with data on May 31, 2020, 80.1% (12,375) passed the quality check. NHs that did not pass the quality check tended to be smaller, for-profit, and with lower five-star ratings.…”

“…Examples of staffing categories include licensed nurses (ie, registered nurses [RNs] and licensed practical nurses [LPNs]), nurse aides that assist licensed nurses and provide direct care to residents (certified nurse aides [CNAs]), clinical staff (ie, physicians and other advanced practice providers), and other ancillary staff (eg, recreation and food services). 12 Research suggests that NHs with higher staffing levels tend to provide better quality of care, 4,6e10,12e16 but low wages, and less-desirable work environments compared with alternatives have made it difficult for NHs to hire and retain staff. 10,17e19 Reliance on government payment models, such as Medicaid, which reimburses at or below actual costs, 20 further limits NHs' ability to increase wages or offer other benefits to hire and retain staff.…”

Inside the Black Box of Improving on Nursing Home Quality Measures

“…Thus, according to providers, the mission or location of a facility can lead to lower performance on the QMs, regardless of the quality of care provided. In addition to more risk adjustment, higher Medicaid rates might encourage facilities to accept more Medicaid residents and provide resources to support better care, such as through higher staffing levels (Bowblis & Applebaum, 2017;Bowblis & Roberts, 2018;Harrington et al, 2016).…”

Occupational Licensing of Social Services and Nursing Home Quality: A Regression Discontinuity Approach

“…Results for two of the three bandwidths are not statistically significant, and no visual discontinuity is apparent in total social services staffing. To the extent that total social services staffing increases, this would likely bias findings toward finding quality improvements, as prior work suggests that increased social services staffing improves SNF quality (Bowblis and Roberts 2018). across inputs, reducing capital or other types of labor to offset the increase in QSWs.…”