The business case for nursing in long-term care

Area of Science:

• Gerontology
• Health Services Research
• Nursing

Background:

• Hospital nurse staffing is linked to patient outcomes, but evidence for nursing homes (NHs) is less clear.
• Long-stay nursing home residents are at risk for adverse events.
• Understanding the impact of direct care time is crucial for NH quality improvement.

Purpose of the Study:

• To examine the association between registered nurse (RN) direct care time and patient outcomes in long-stay NH residents.
• To evaluate potential cost savings from reduced adverse outcomes versus increased staffing wages.
• To determine the economic impact of adequate RN staffing in NHs.

Main Methods:

• Analysis of data from the National Pressure Ulcer Long-Term Care Study, including 1,376 at-risk residents across 82 NHs.
• Utilized medical records for primary data and national statistics for cost analysis (hospitalization, pressure ulcer treatment, UTI).
• Calculated annual net societal benefit over a 1-year time horizon.

Main Results:

• Higher RN direct care time per resident per day was associated with fewer pressure ulcers (PrUs), hospitalizations, and urinary tract infections (UTIs).
• Annual net societal benefit reached $3,191 per resident/year in high-risk NH units with 30-40 min of RN time/resident/day compared to units with <10 min.
• These findings held after controlling for significant variables.

Conclusions:

• Increased registered nurse (RN) direct care time in nursing homes is strongly associated with improved patient outcomes.
• Adequate RN staffing in NHs leads to significant societal cost savings through the reduction of adverse events.
• Investing in higher RN staffing levels is a cost-effective strategy for enhancing NH quality of care.