Affiliation:
1. Department of Medicine, Division of General Internal Medicine University of California Irvine California USA
2. Department of Medicine, iTEQC Research Program University of California Irvine California USA
3. Los Angeles Borun Center at David Geffen School of Medicine University of California Los Angeles California USA
4. Veterans Administration GRECC Los Angeles California USA
5. RAND Health Santa Monica California USA
6. Department of Public Health Sciences The University of Chicago Chicago Illinois USA
Abstract
AbstractObjectiveTo estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality.Data Sources and Study SettingA national sample of nursing homes during 2017–2019 (pre‐COVID). Data included the Payroll‐Based Journal, Medicare Claims, Nursing Home Care Compare, and Long‐Term Care Focus.Study DesignRetrospective, regression analyses. We estimated separate linear models predicting six long‐term facility‐level outcomes. Independent variables included staffing hours per resident‐day (HPRD) interacted with the facility percentage of dementia residents, controlling for other resident and facility characteristics.Data Collection/Extraction MethodsHospital‐based nursing homes, those with fewer than 30% dementia residents, and missing data were excluded.Principal FindingsWe found that registered nurses and certified nurse assistants HPRDs were likely to exhibit positive returns in terms of outcomes throughout most of the range of HPRD for both high and low‐census dementia facilities, although, high‐ and low‐dementia facilities differed in most outcome rates at all staffing levels. Average predicted antipsychotics and activities of daily living as functions of HPRD were worse in higher dementia facilities, independent movement, and hospitalizations did not differ significantly, and Emergency Rooms and pressure sores were worse in lower dementia facilities. Average marginal effects were not statistically different [CI included zero] between the high and low dementia facilities for any outcome.ConclusionsThese findings suggest that increasing staffing will improve outcomes by similar increments in both low‐ and high‐dementia facilities for all outcomes. However, at any given level of staffing, absolute differences in outcomes between low‐ and high‐dementia facilities remain, suggesting that additional staffing alone will not suffice to close these gaps. Further studies are required to identify opportunities for improvement in performance for both low‐ and high‐dementia census facilities.
Funder
National Institute on Aging