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Nursing home staffing, turnover, and case mix
Charlene Harrington1, James H Swan
1University of California, USA.
Medical Care Research and Review : MCRR
|September 16, 2003
Summary
Nursing home staffing levels are influenced by resident needs and payer mix. Higher Medicare residents correlated with more hours, while Medicaid residents were linked to fewer hours and higher turnover.
Area of Science:
- Gerontology
- Health Services Research
- Nursing Home Administration
Background:
- Adequate nurse staffing is crucial for nursing home quality of care.
- Understanding staffing predictors is vital for resource allocation and policy development.
Purpose of the Study:
- To identify key predictors of total nurse and registered nurse (RN) staffing hours per resident day.
- To analyze the impact of resident case mix, staffing turnover, and facility characteristics on staffing levels.
Main Methods:
- Utilized a two-stage least squares model.
- Analyzed 1999 California nursing home cost report data (1,555 facilities).
- Examined relationships between staffing hours, turnover rates, resident case mix, and facility factors.
Main Results:
- Total nurse and RN staffing hours were negatively associated with nurse staff turnover and positively associated with resident case mix.
- Higher proportions of Medicare residents predicted increased staffing, while Medicaid residents predicted decreased staffing and higher turnover.
- For-profit status and high occupancy rates were linked to lower staffing hours.
- Nursing assistant wages, Medicaid reimbursement rates, and multifacility organization were positively associated with staffing hours.
Conclusions:
- Nursing home staffing is significantly influenced by resident payer mix and facility operational characteristics.
- Policies should consider the complex interplay of financial incentives, resident needs, and operational factors to optimize nurse staffing.