Is Higher Nurse Aide Retention Associated with Fewer Nursing Home Allegations and Complaints?

Abstract Consumer voices are often left out from assessments of nursing home (NH) quality. For this reason, consumer allegations and complaints against nursing homes were studied in relation to facility rates of nurse aide retention. Analyses involved means and frequencies, correlations, ANOVAs with Tukey correction to examine the independent and dependent variables (N=690). Four quartiles of retention were created. In the final models, medium, high, and extremely high retention facilities are compared to the low retention facilities. Negative binomial regressions were estimated on total, substantiated, and unsubstantiated counts of allegations and complaints. All regressions controlled for the same characteristics, including nurse aide empowerment, consistent assignment, administrator turnover, director of nursing turnover, average age of residents, and percent female. The correlation between retention and the dependent variables was negative and statistically significant (r=-0.11, p<.01). The ANOVAs showed that high retention NHs (61-72%) received significantly fewer allegations than low (0-48%) and medium (49-60%) retention NHs; they also received fewer unsubstantiated allegations, and fewer complaints, both substantiated and unsubstantiated. After controlling for other variables, each retention group was significantly related to having fewer allegations and complaints compared to the low retention NHs. Notably, high retention NHs received between 29 and 35% fewer allegations and complaints of all types. Unexpectedly, extremely high retention NHs had more allegations, complaints, and unsubstantiated allegations than high retention NHs. Policy and practice have a role to promote nurse aide retention, improve job quality, and ensure adequate support for this critical, in-demand workforce.

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Nurse Aide Retention in Nursing Homes

The Gerontologist ◽

10.1093/geront/gnz168 ◽

2020 ◽

Vol 60 (5) ◽

pp. 885-895 ◽

Cited By ~ 7

Author(s):

Nicholas G Castle ◽

Kathryn Hyer ◽

John A Harris ◽

John Engberg

Keyword(s):

Quality Indicators ◽

Negative Binomial ◽

Poor Performance ◽

Negative Binomial Regression ◽

Nursing Facilities ◽

Regression Analyses ◽

Policy And Practice ◽

Nurse Aide ◽

Survey Responses ◽

Design And Methods

Abstract Background and Objectives The association of nurse aide retention with three quality indicators is examined. Retention is defined as the proportion of staff continuously employed in the same facility for a defined period of time. Research Design and Methods Data used in this investigation came from survey responses from 3,550 nursing facilities, Certification and Survey Provider Enhanced Reporting data, and the Area Resource File. Staffing characteristics, quality indicators, facility, and market information from these data sources were all measured in 2016. Nurse aide retention was measured at 1, 2, and 3 years of employment. The quality indicators examined were a count of all deficiency citations, quality of care deficiency citations, and J, K, L deficiency citations. Negative binomial regression analyses were used to study the associations between the three different retention measures and these three quality indicators. Results The 1-, 2-, and 3-year nurse aide retention measures were 53.2%, 41.4%, and 36.1%, respectively. The regression analyses show low levels of retention to be generally associated with poor performance on the three deficiency citation quality indicators examined. Discussion and Implications The research presented starts to provide information on nurse aide retention as an important workforce challenge and its potential impact on quality. Retention may be an additional staffing characteristic of nursing facilities with substantial policy and practice relevance.

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When Is a Nursing Home Complaint Really a Complaint? Making Sense Out of Increased Complaints in U.S. Nursing Homes

Innovation in Aging ◽

10.1093/geroni/igab046.3090 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 852-853

Author(s):

Xiao Qiu ◽

Jane Straker ◽

Katherine Abbott

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Urban Areas ◽

Family Satisfaction ◽

Term Care ◽

Making Sense ◽

Nurse Aide ◽

Nursing Home Quality ◽

Director Of Nursing ◽

Occupancy Rates

Abstract Official complaints are one tool for addressing nursing home quality concerns in a timely manner. Similar to trends nationwide, the Ohio Department of Health (ODH) has noticed a trend in increasing nursing home complaints and has partnered with the Scripps Gerontology Center to learn more about facilities that receive complaints. Greater understanding may lead to proactive approaches to addressing and preventing issues. This study relies on two years of statewide Ohio nursing home complaint data. Between 2018 and 2019, the average complaint rate per 100 residents went from 6.59 to 7.06, with more than 70% of complaints unsubstantiated. Complaint information from 629 Ohio nursing homes in 2018 was linked with Centers for Medicare and Medicaid Services Nursing Home Compare data, the Ohio Biennial Survey of Long-Term Care Facilities, and Ohio Nursing Home Resident and Family Satisfaction Surveys. Using ordered logistic regression analyses, we investigated nursing home providers' characteristics using different levels of complaints and substantiated complaints. Findings suggest that providers with higher complaint rates are located in urban areas, had administrator and/or director of nursing (DON) turnover in the previous 3 years, experienced decreased occupancy rates, had reduced nurse aide retention, and received lower family satisfaction scores. Additionally, providers with administrator and/or DON turnover, and low family satisfaction scores are more likely to have substantiated complaints. Because increasing numbers of complaints are accompanied by relatively low substantiation rates, policy interventions targeted to specific types of providers may improve the cost-effectiveness of complaint resolution, as well as the quality of care.

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Analyzing Nursing Home Complaints: From Substantiated Allegation to Deficiency Citations

Innovation in Aging ◽

10.1093/geroni/igaa057.271 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 82-83

Author(s):

Kallol Kumar Bhattacharyya ◽

Lindsay Peterson ◽

John Bowblis ◽

Kathryn Hyer

Keyword(s):

Nursing Home ◽

Quality Of Care ◽

Nursing Homes ◽

Staff Training ◽

Policy And Practice ◽

Abuse And Neglect ◽

The Relationship ◽

Investigation Process

Abstract Complaints provide important information to consumers about nursing homes (NHs). Complaints that are substantiated often lead to an investigation and potentially a deficiency citation. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Because a complaint may contain multiple allegations, and the data do not identify which allegation(s) lead to a complaint’s substantiation, we identified all substantiated single allegation complaints for NHs in 2017. Our data were drawn from federally collected NH complaint and inspection records. Among the 369 substantiated single-allegation complaints, we found most were categorized as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Of the deficiency citations resulting from complaints in our sample, 27.9% were categorized as quality of care and 19.5% were in the category of resident behavior and facility practices, which includes abuse and neglect. While two-thirds (N=239) of the substantiated complaints generated from 1 to 19 deficiency citations, nearly one third had no citations. Surprisingly, 28% of substantiated abuse and neglect allegations resulted in no deficiency citations. More surprisingly, a fifth of complaints that were categorized as “immediate jeopardy” at intake did not result in any deficiency citations. We also found a number of asymmetries in the allegation categories suggesting different processes by Centers for Medicare and Medicaid Services (CMS) region. These results suggest that the compliant investigation process warrants further investigation. Other policy and practice implications, including the need for better and more uniform investigation processes and staff training, will be discussed.

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Influenza Vaccination Coverage of Healthcare Workers in Nursing Homes in France and Related Determinants, 2018- 2019 Season: A Cross-Sectional Survey

10.21203/rs.3.rs-934635/v1 ◽

2021 ◽

Author(s):

Sophie Vaux ◽

Laure Fonteneau ◽

Anne-Gaëlle Venier ◽

Arnaud Gautier ◽

Sophan Soing Altrach ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

Healthcare Workers ◽

Negative Binomial ◽

Nursing Assistants ◽

Influenza Vaccines ◽

Cross Sectional Survey ◽

Cross Sectional

Abstract Background The burden of influenza morbidity and mortality in nursing homes (NH) is high. Vaccination of residents and healthcare workers (HCW) is the main prevention strategy. Despite recommendations, HCW vaccination coverage is generally low. Methods We performed a nationwide cross-sectional survey of NH using a single-stage stratified random sampling design to estimate influenza vaccination coverage in nursing home HCW in France during the 2019-2020 season, and to identify measures likely to increase it. A multivariate analysis was performed using a negative binomial regression. Results Overall influenza vaccination coverage in HCW was 31.9% (95% CI [29.7-34.1]). It varied according to occupational category: 75.5% [69.3-81.7] for physicians, 42.9% [39.4-46.4] for nurses, 26.7% [24.5-29.0] for nursing assistants, and 34.0% [30.1-38.0] for other paramedical personnel. When considering all professionals (i.e., HCW and non-medical professionals), overall vaccination coverage was 30.6% [28.2-33.0]. Vaccination coverage was higher in private nursing homes, in i) small nursing homes, ii) when vaccination was offered free of charge (RRa: 1.4, [1.1-1.8]), iii) when vaccination promotion for professionals included individual (RRa: 1.6 [1.1-2.1]) or collective (RRa: 1.3 [1.1-1.5]) information sessions, videos or games (RRa: 1.4 [1.2-1.6], iv) when information on influenza vaccines was provided (RRa: 1.2 [1.0-1.3], and finally, vi) when a vaccination point of contact - defined as an HCW who could provide reliable information on vaccination - was nominated within the nursing home (RRa: 1.7 [1.3-2.2]). Conclusions Urgent and innovative actions are required to increase coverage in HCW. Vaccination programmes should include free vaccination and education campaigns, and particularly target nursing assistants. The results of this nationwide study provide keys for improving influenza vaccination coverage in HCW. Programmes should ensure that information on influenza vaccines is provided by a vaccination point of contact in NH using attractive media. Combining the different prevention measures proposed could increase coverage in NH nationwide by over 50%.

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“Medication Is Just One Piece of the Whole Puzzle”: How Nursing Homes Change Their Use of Antipsychotic Medications

Journal of Applied Gerontology ◽

10.1177/0733464820958919 ◽

2020 ◽

pp. 073346482095891

Author(s):

Marsha Rosenthal ◽

Jessica Poling ◽

Aleksandra Wec ◽

Elizabeth Connolly ◽

Beth Angell ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Research Policy ◽

Nursing Home Residents ◽

Dementia Care ◽

Policy And Practice ◽

Antipsychotic Medications ◽

Positive Attitudes ◽

National Partnership ◽

Person Centered Approach

Antipsychotic medication use for nursing home residents with dementia poses major patient safety challenges. This article investigates health professionals’ experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes (National Partnership) and its companion state coalitions. These programs were introduced in 2012 to encourage reductions in antipsychotic use and increased use of nonpharmacological treatments for dementia. Interviews with 40 nursing home physicians and staff in seven states found that reducing antipsychotics is more time and resource-intensive than relying on medication, because it requires a person-centered approach. However, respondents supported reductions in antipsychotic use, and indicated that with sufficient staffing, effective communications, and training, they could create or implement individualized treatments. Their positive attitudes suggest that the National Partnership has been a catalyst in reducing antipsychotic medications, and their perspectives can inform further research, policy and practice in nursing homes toward achieving quality dementia care.

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