title: Cost analysis of nursing home registered nurse staffing times.
abstract: OBJECTIVE
  To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing.
  
  
  METHODS
  A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing.
  
  
  METHODS
  Eighty-two nursing homes throughout the United States.
  
  
  METHODS
  One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development.
  
  
  METHODS
  Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional.
  
  
  RESULTS
  Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold.
  
  
  CONCLUSIONS
  Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.
authors.affiliation: Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon 97239, USA. dorrd@ohsu.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Dorr
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Smout
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D016330:Frail Elderly; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D009726:Nurses / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000191:economics*; D003668:Pressure Ulcer / Q000191:economics; D012189:Retrospective Studies; D014481:United States; D014552:Urinary Tract Infections / Q000191:economics; D000078329:Workforce