Policy brief: Registered nurse staffing requirements in nursing homes

In the past two decades, many nursing homes converted their ownership status from nonprofit to for-profit (NP-to-FP). These conversions have drawn public scrutiny and triggered a debate about the implications of ownership conversions on nursing home performance. Exploring a nationwide panel data set of U.S. nursing homes from 2006 to 2017, we observe that nursing homes with higher financial distress are associated with higher likelihood of NP-to-FP conversions. The postconversion operating margins increased significantly. Converted nursing homes improved their financial performance by reducing operating costs while keeping net resident revenues unchanged. Both cutting registered nurse staffing and cutting overhead staffing contributed to reductions in operating costs; however, only the former cost-reduction measure had a negative impact on quality. On average, the postconversion quality of care declined. The effects of NP-to-FP conversions on nursing homes were moderated by preconversion financial distress: High-distress nursing homes aggressively cut registered nurse staffing and experienced severe quality decline, whereas low-distress ones kept registered nurse staffing unchanged and largely avoided quality decline. These findings lead to both policy and managerial insights. To nursing home regulators, we recommend increased oversight on NP-to-FP conversions of nursing homes with high preconversion financial distress. To managers of nursing homes undergoing NP-to-FP conversions, our findings suggest that although cost reduction is an effective strategy to improve financial performance, they need to avoid the pitfall of cutting registered nurse staffing and instead focus on streamlining overhead operations in order to increase operating efficiency without compromising quality. This paper was accepted by Stefan Scholtes, healthcare management.

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24/7 Registered Nurse Staffing Coverage in Saskatchewan Nursing Homes and Acute Hospital Use

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980815000434 ◽

2015 ◽

Vol 34 (4) ◽

pp. 492-505 ◽

Cited By ~ 5

Author(s):

Margaret J. McGregor ◽

Janice M. Murphy ◽

Jeffrey W. Poss ◽

Kimberlyn M. McGrail ◽

Lisa Kuramoto ◽

...

Keyword(s):

Nursing Homes ◽

Registered Nurse ◽

Nurse Staffing ◽

Acute Hospital ◽

Personnel Infirmier ◽

Longue Duree ◽

Longue Durée ◽

Hospital Use

RÉSUMÉLa législation, dans de nombreuses juridictions, nécessite les établissements des soins de longue durée (SLD) d'avoir une infirmière en service 24 heures par jour, 7 jours par semaine. Bien que la recherche considérable existe sur l'intensité SLD de la dotation en personnel infirmier, il n'existe pas de la recherche empirique relative à cette exigence. Notre étude rétrospectif d'observation a comparé des installations en Saskatchewan avec 24/7 RN couverture aux établissements offrant moins de couverture, complétées par divers modèles de dotation des postes de nuit. Les ratios de risque associés à moins de 24/7 couverture RN complété de la dotation infirmière autorisé de nuit, ajusté pour l'intensité de dotation en personnel infirmier et d'autres facteurs de confusion potentiels, étaient de 1,17, IC 95% [0,91, 1,50] et 1.00, IC à 95% [0,72, 1,39], et avec moins de couverture 24/7 RN complété avec soin par aides personnels de nuit, les ratios de risque étaient de 1,46, IC 95% [1,11, 1,91] et 1,11, IC 95% [0,78, 1,58], pour les patients hospitalisés et de visites aux services d'urgence, respectivement. Ces résultats suggèrent que l'utilisation des soins de courte durée peut être influencée négativement par l'absence de la couverture 24/7 RN.

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