Elderly/Long-Term Care

Adding more staff may be a necessary, but insufficient, way to improve nursing home quality

Adding more staff is necessary for improving nursing home quality, but not sufficient. Some accounting for use of agency staff, staff stability, and professional staff mix is also needed, suggests a new study. To get a better picture of the impact of staffing on nursing home quality of care, Nicholas G. Castle, Ph.D., of the University of Pittsburgh, and John Engberg, Ph.D., of the RAND Corporation, examined survey data from 6,005 nursing home administrators, the online Nursing Home Compare Web site, and other data sources to identify staffing characteristics, care quality indicators, and facility and market information for 2004.

Staffing levels alone were weakly associated with the quality measures examined. However, more fully specified models that included agency staff (temporary workers hired by the facility), stability (number of staff who have worked at the facility for 5 or more years), and professional staff mix (ratio of registered nurses or RNs to other caregivers) did link staffing levels with the quality measures.

Thus, mandated minimum staffing levels by some States may not address the quality-of-care problem. A better approach might be to specify minimum ratios of RNs (some states already do this) and maximum levels of agency staff. Also, staff stability could be improved by improving job satisfaction of caregivers, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS16808).

See "Further examination of the influence of caregiver staffing levels on nursing home quality," by Drs. Castle and Engberg, in the August 2008 Gerontologist 48(4), pp. 464-476.

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