Nursing Home Staffing, Turnover, and Case Mix

Abstract

This study examined the predictors of total nurse and registered nurse (RN) staffing hours per resident day separately in all free-standing California nursing homes (1,555), using staffing data from state cost reports in 1999. This study used a two-stage least squares model, taking into account nursing turnover rates, resident case mix levels, and other factors. As expected, total nurse and RN staffing hours were negatively associated with nurse staff turnover rates and positively associated with resident case mix. Facilities were resource dependent in that a high proportion of Medicare residents predicted higher staffing hours, and a higher proportion of Medicaid residents predicted lower staffing hours and higher turnover rates. Nursing assistant wages were positively associated with total nurse staffing hours. For-profit facilities and high-occupancy rate facilities had lower total nurse and RN staffing hours. Medicaid reimbursement rates and multifacility organizations were positively associated with RN staffing hours.

The Impact of State Nursing Home Staffing Standards on Nurse Staffing Levels

“…As residents with higher case-mix levels require more extensive care in general (Wunderlich & Kohler, 2001), higher acuity facilities have been found to have higher overall staffing levels (or RN and/or LPN staffing levels) (Harrington, Carrillo, Mullan, & Swan, 1998;Harrington et al, 2007;Harrington & Swan, 2003;Mueller et al, 2006). In addition, case-mix reimbursement methods have been used for Medicare reimbursement and increasingly adopted by many sates (35 states by 2004) for Medicaid reimbursement (Zinn, Feng, Mor, Intrator, & Grabowski, 2008).…”

Job Satisfaction of Nurse Aides in Nursing Homes: Intent to Leave and Turnover

“…We modified the model to be representative of the nursing home context; for example, we included facility characteristics that have had prior robust associations with turnover (e.g., Harrington & Swan, 2003).…”

“…Most significantly, job satisfaction of caregivers in other health care settings is directly associated with turnover (Irvine & Evans, 1995). Given the high nurse aide turnover in many nursing homes (Harrington & Swan, 2003), we may have an opportunity to improve these rates by further understanding the relationship between job satisfaction of nurse aides and turnover in these facilities.…”

Iowa Certified Nursing Assistants StudySelf-Reported Ratings of the Nursing Home Work Environment

“…The validity and reliability of these data are discussed elsewhere (Castle & Lowe, 2005;Wardell, 2003), but worth noting is the issue of overreporting of staff hours (Harrington, 2005). It is also probable that facilities with a high proportion of Medicare residents have better staffing ratios than those with more Medicaid residents because the reimbursement rate to nursing homes from Medicare is greater (Harrington & Swan, 2003).…”

“…Several studies have examined the CNA workforce in LTC in relation to staff burnout, the effects of work assignments, staffing patterns, job enrichment, and personal growth opportunities (Burgio, Fisher, Fairchild, Scilley, & Hardin, 2004;Harrington & Swan, 2003;Parsons, Simmons, Penn, & Furlough, 2003;Secrest, Iorio, & Martz, 2005), but few have focused on the actual perceptions of CNAs regarding their work environment. The role of perceptions of the work environment in CNA turnover is unknown because few nursing homes, including those in Iowa, conduct exit interviews with terminating CNAs.…”