Nursing Home Staffing and Its Relationship to Deficiencies

Abstract

Facility characteristics and states were stronger predictors of deficiencies than were staffing hours and resident characteristics. Because only a small portion of the total variance in deficiencies could be explained, much work remains to explore factors that influence deficiencies.

Functional disability of older persons in long-term care facilities in Korea

“…For example, facility characteristics, such as facility size and the number of trained personnel, known to affect facility deficiencies (Harrington et al, 2000), were not included in the study. Future studies will need to consider measures that assess quality of care and standards of care delivered at these facilities.…”

The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession

“…sources of quality of care in nursing homes and has been used in studies on the nursing home industry in California (Harrington et al 2000;Matsudaira 2014). The first measure utilized is the number of regulatory deficiencies a facility received during their federal regulatory inspection.…”

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

“…Facilities with higher percentages of Medicaid residents have been found to be associated with more deficiencies [38][39], higher odds of hospitalization [40][41], more complaints [42], higher likelihood of voluntary or involuntary terminations [39,43], higher rates of antipsychotic medication prescription [39,44], and higher rates of physical restraint use and pressure ulcers [39]. Nursing homes with higher proportions of black residents and rural nursing homes also exhibited worse processes and outcomes [45][46][47].…”

“…Empirical evidence suggests that higher nursing staff levels (hours per resident day) and higher skilled nursing staff mix (proportion of professional nursing staff such as registered nurses) were associated with better quality of care as measured by processes of care and patient outcomes [38,40,[50][51][52][53]. Although the Nursing Home Reform Act required that a nursing facility certified for Medicare and Medicaid had sufficient nursing staff to provide nursing care to all residents in accordance with resident care plans, it did not specify the nurse-to-resident staffing ratios and the adequacy of the federal regulations with regard to nurse staffing has long been criticized [54][55][56].…”

“…Research has suggested that more skilled nurse staffing especially greater RN staffing was associated with higher quality of care. Examples include lower likelihood of pressure ulcers and urinary tract infections [124,144], lower probability of malpractice paid-losses [194], fewer deficiency citations [38,195], lower rates of physical restraint use [53], fewer hospitalizations [144], improved survival [50][51] and better functional status [50]. Furthermore, although the increase in licensed nurse hours was modest in size on average, to improve quality nursing homes could best use scarce resources by highlighting at-risk residents and modifying care practices for these residents [196], rather than increase the nursing staff time for all residents.…”