title: Frontline caregiver daily practices: a comparison study of traditional nursing homes and the Green House project sites.
abstract: OBJECTIVE
  To describe differences in frontline caregiver daily practice in two types of skilled nursing facility (SNF) settings, Green House (GH) homes and traditional SNF units, related to overall staffing (nursing and nonnursing departments), direct care and indirect care time per resident day, and staff time interacting with residents.
  
  
  METHODS
  Observational, interview, and survey study comparing frontline caregiver daily practice in GH homes and traditional SNFs.
  
  
  METHODS
  Twenty-seven sites (GH homes and traditional SNF units).
  
  
  METHODS
  Two hundred forty staff from participating sites.
  
  
  METHODS
  Site and resident characteristics, nursing and nonnursing department staff hours per resident day (HPRDs), certified nursing assistant (CNA) direct and indirect care HPRDs, and CNA HPRDs engaged with residents.
  
  
  RESULTS
  Staffing from nursing and nonnursing departments combined, excluding administrative, was 0.3 less HPRDs (18 minutes) in GH homes than in traditional SNFs. CNAs in GH homes, although responsible for more nonnursing activities such as laundry and housekeeping, spent 0.4 more HPRDs (24 minutes) in direct care activities than CNAs in traditional SNFs.
  
  
  CONCLUSIONS
  The results challenge the assumption that staffing efficiencies cannot be achieved in small environments such as a GH home. Although the GH model has higher ratio of CNA staff to residents than traditional SNF units, overall staff time (combined total of nursing and nonnursing HPRDs) is slightly less in GH homes. The GH model allows for expanded responsibilities of CNAs in indirect care activities and more time in direct care activities and engaging directly with resident.
authors.affiliation: Health Management Strategies, Austin, Texas, USA. ssharkey@hmstrat.com
authors.forename: Siobhan S
authors.initials: SS
authors.lastname: Sharkey
authors.forename: Sandra
authors.initials: S
authors.lastname: Hudak
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.forename: Bobbie
authors.initials: B
authors.lastname: James
authors.forename: Jessie
authors.initials: J
authors.lastname: Howes
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003688:Deinstitutionalization; D016352:Group Homes / Q000458:organization & administration*; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D017146:Models, Organizational; D018802:Patient-Centered Care / Q000379:methods* / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling; D057184:Practice Patterns, Nurses'; D017064:Process Assessment, Health Care; D012866:Skilled Nursing Facilities / Q000458:organization & administration*; D013647:Task Performance and Analysis; D000078329:Workforce