scholarly journals Article Commentary: The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes

2016 ◽  
Vol 9 ◽  
pp. HSI.S38994 ◽  
Author(s):  
Charlene Harrington ◽  
John F. Schnelle ◽  
Margaret McGregor ◽  
Sandra F. Simmons
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Incentives ◽  
Positive Relationship ◽  
Nurse Staffing ◽  
Federal Regulations ◽  
Political Strategies ◽  
Political Opposition ◽  
Staffing Levels ◽  
Nursing Home Quality

Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality.

scholarly journals Appropriate Nurse Staffing Levels for U.S. Nursing Homes

2020 ◽  
Vol 13 ◽  
pp. 117863292093478 ◽  
Author(s):  
Charlene Harrington ◽  
Mary Ellen Dellefield ◽  
Elizabeth Halifax ◽  
Mary Louise Fleming ◽  
Debra Bakerjian
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Staff ◽  
Nurse Staffing ◽  
Well Being ◽  
Data Sources ◽  
Care Needs ◽  
Staffing Levels ◽  
Nursing Staffing ◽  
Adequate Staffing

US nursing homes are required to have sufficient nursing staff with the appropriate competencies to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident. Minimum nurse staffing levels have been identified in research studies and recommended by experts. Beyond the minimum levels, nursing homes must take into account the resident acuity to assure they have adequate staffing levels to meet the needs of residents. This paper presents a guide for determining whether a nursing home has adequate and appropriate nurse staffing. We propose five basic steps to: (1) determine the collective resident acuity and care needs, (2) determine the actual nurse staffing levels, (3) identify appropriate nurse staffing levels to meet residents care needs, (4) examine evidence regarding the adequacy of staffing, and (5) identify gaps between the actual staffing and the appropriate nursing staffing levels based on resident acuity. Data sources and specific methodologies are analyzed, compared, and recommended. The goal is to assist nursing home nurses and administrators to ensure adequate nursing home staffing levels that protect resident health, safety, and well-being.

scholarly journals CONSISTENT ASSIGNMENT: AN UPDATE ON THE QUALITY IMPACT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S802-S802
Author(s):  
Nicholas Castle ◽  
John A Harris
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Family Satisfaction ◽  
Nursing Home Administrators ◽  
Logistic Regression Models ◽  
Staffing Levels ◽  
Nursing Home Quality ◽  
Resource File ◽  
Low Levels ◽  
Nurse Aides

Abstract The association of consistent assignment of Nurse Aides (NAs) with nursing home quality indicators is examined. Consistent assignment is defined as the same caregivers consistently caring for the same residents almost (80% of their shifts) every time they are on duty. Data used came from a survey of nursing home administrators, Nursing Home Compare, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Several multivariate logistic regression models (using GEE) were used, including staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). An average of 77% of nursing homes reported using at least some level of consistent assignment; although some were at low levels. In the multivariate analyses, accepted levels of consistent assignment were used. Turnover and family satisfaction quality were significantly (p<.01) better in facilities with the highest levels of consistent NA assignment. 7 of the 9 Quality Measures and 3 of the 5 Five-Star measures examined were significantly (p<.01) better in facilities with the highest levels of consistent NA assignment. Consistent assignment has developed as a preferred practice in nursing homes based on little empirical evidence. The findings presented here provide substantial justification for the use of this staffing practice for NAs.

scholarly journals Decomposing Racial and Ethnic Disparities in Nursing Home Quality of Life

2020 ◽  
pp. 073346482094665
Author(s):  
John R. Bowblis ◽  
Weiwen Ng ◽  
Odichinma Akosionu ◽  
Tetyana P. Shippee
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Structural Characteristics ◽  
Ethnic Disparities ◽  
People Of Color ◽  
Racial And Ethnic Disparities ◽  
Staffing Levels ◽  
Nursing Home Quality ◽  
Racial Ethnic

This study examines the racial/ethnic disparity among nursing home (NH) residents using a self-reported, validated measure of quality of life (QoL) among long-stay residents in Minnesota. Blinder–Oaxaca decomposition techniques determine which resident and facility factors are the potential sources of the racial/ethnic disparities in QoL. Black, Indigenous, and other People of Color (BIPOC) report lower QoL than White residents. Facility structural characteristics and being a NH with a high proportion of residents who are BIPOC are the factors that have the largest explanatory share of the disparity. Modifiable characteristics like staffing levels explain a small share of the disparity. To improve the QoL of BIPOC NH residents, efforts need to focus on addressing systemic disparities for NHs with a high proportion of residents who are BIPOC.

scholarly journals EVALUATING THE EVIDENCE BASE OF A STAFFING GUIDELINE FOR DUTCH NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S381-S381
Author(s):  
Ramona Backhaus ◽  
Hilde Verbeek ◽  
Bram De Boer ◽  
Erik Van Rossum ◽  
Jos Schols ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Home ◽  
Nursing Homes ◽  
Scientific Literature ◽  
Evidence Base ◽  
Care Provision ◽  
Ministry Of Health ◽  
Nursing Home Quality ◽  
Quality Framework ◽  
Board Level

Abstract Related to the Dutch nursing home quality framework implemented in 2017, a staffing guideline was developed, aimed at assisting nursing homes to adequately staff their wards. For the Dutch Ministry of Health, we investigated the evidence base of this guideline. We critically reviewed scientific literature (n=65) and interviewed (inter)national experts (n=8) and potential guideline users (n=5). We found that departing a quality improvement dialogue directly from teams, clients and their families is positive. However, weaknesses were identified as well. Several risks exist for employees to adequately assess resident needs. Furthermore, buy-in is needed from board level to develop a vision on which competencies and amount of staff are needed to fulfill these needs. Examples of guideline improvement recommendations were assisting teams in how to assess resident needs, critically reflect on care provision and considering a role for (top)management. Overall, it was concluded that the value of the guideline was limited.

scholarly journals Nurse Staffing and Coronavirus Infections in California Nursing Homes

2020 ◽  
Vol 21 (3) ◽  
pp. 174-186 ◽  
Author(s):  
Charlene Harrington ◽  
Leslie Ross ◽  
Susan Chapman ◽  
Elizabeth Halifax ◽  
Bruce Spurlock ◽  
...  
Keyword(s):  
Los Angeles ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Nurse Staffing ◽  
The United States ◽  
Study Data ◽  
Chronic Illnesses ◽  
Staffing Levels ◽  
Control Procedures ◽  
Relationship Of

In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.

scholarly journals Approaches to quality improvement in nursing homes: Lessons learned from the six-state pilot of CMS's Nursing Home Quality Initiative

2003 ◽  
Vol 3 (1) ◽  
Author(s):  
Stephanie Kissam ◽  
David Gifford ◽  
Peggy Parks ◽  
Gail Patry ◽  
Laura Palmer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Home ◽  
Nursing Homes ◽  
Lessons Learned ◽  
Nursing Home Quality

scholarly journals A qualitative assessment of factors affecting nursing home caregiving staff experiences during the COVID-19 pandemic

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260055
Author(s):  
Rachel L. Snyder ◽  
Laura E. Anderson ◽  
Katelyn A. White ◽  
Stephanie Tavitian ◽  
Lucy V. Fike ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Focus Groups ◽  
Financial Incentives ◽  
Well Being ◽  
The United States ◽  
Qualitative Assessment ◽  
Simple Random Sample ◽  
Nursing Home Staff ◽  
The Impact

Background A large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes. Methods Based on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel. Results Throughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups. Conclusions Addressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.

Amazing numbers and bottom rankings: the reporting of nursing home resident user surveys in the press

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Elisabeth Carlstedt ◽  
Håkan Jönson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Media Representations ◽  
Nursing Home Care ◽  
User Survey ◽  
Content Type ◽  
User Perceptions ◽  
Nursing Home Quality ◽  
Survey Results ◽  
Media Reports

PurposeMedia reporting is one of many circumstances that nursing homes have to relate to, because of the reputational risks. The aim of this article is to investigate media representations of Swedish nursing homes in relation to reports on an annual national user survey.Design/methodology/approachThe empirical data consist of 381 Swedish newspaper articles about the survey results. The questions guiding the analysis were: what messages on nursing homes are communicated, and how are claims organized in order to appear factual?FindingsThe data show that press reports focus on comparisons of care units' survey results, eldercare representatives' explanations of the results, and what improvements will be made in order to do better in the next year's survey. With their use of truth-making rhetoric, press articles construct survey results as credible and valid, thus mirroring user perceptions and ultimately nursing home quality. The selection of nursing home representatives' comments equally reinforces the validity of claims.Originality/valueGiven nursing homes' problems with demonstrating success, the authors argue that media reports on the user survey is a way for eldercare organizations to achieve results in an otherwise resultless field, and while media reports might be seen as prompting change in nursing home care, what is ultimately achieved is the legitimation of a costly survey with low response rate.

scholarly journals Nursing Home Staffing Standards: Their Relationship to Nurse Staffing Levels

2006 ◽  
Vol 46 (1) ◽  
pp. 74-80 ◽  
Author(s):  
Christine Mueller ◽  
Greg Arling ◽  
Robert Kane ◽  
Julie Bershadsky ◽  
Diane Holland ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nurse Staffing ◽  
Staffing Levels
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