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.