Nursing effort and quality of care for nursing home residents.
OBJECTIVE
The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes.


METHODS
Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado, Indiana, Minnesota, and Mississippi). We linked residents' care times to their measures of health and functioning from Minimum Data Set assessments. Major variables were unit- and resident-specific minutes of care per day, process measures (physical restraints, range of motion, toileting program, and training in activities of daily living [ADLs]), outcome measures (ADL decline, mobility decline, and worsening behavior between the time study and 90-day follow-up), and covariates such as unit type and resident health status. We used multilevel analysis to examine staffing and quality relationships.


RESULTS
Residents with toileting programs, range of motion or ADL training, and restraints received significantly more care from unlicensed but not from licensed staff. However, functional outcomes were not significantly related to care received from licensed or unlicensed staff, except for ADL decline, which was greatest for residents receiving more unlicensed minutes of care. Unit staffing level (licensed and unlicensed) was unrelated to any of the care processes or outcome measures, although higher overall staffing was associated with more time devoted to direct resident care.


CONCLUSIONS
Future research into nursing home quality should focus on organization and delivery rather than simply the amount of care available.
Arling
Greg
G
Indiana University Center for Aging Research, Regenstrief Institute, HITS Building Room 2000, 410 West 10 Street, Indianapolis, IN 46202-3012, USA. GArling@iupui.edu
Kane
Robert L
RL
Mueller
Christine
C
Bershadsky
Julie
J
Degenholtz
Howard B
HB
D000203:Activities of Daily Living; D000369:Aged, 80 and over; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009735:Nursing Homes; D009740:Nursing Staff / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care; D014481:United States