title: The influence of nurse staffing levels on quality of care in nursing homes.
abstract: OBJECTIVE
  This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period.
  
  
  METHODS
  Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing levels and deficiency citations for 663 Florida nursing homes between 2002 and 2005. Using a generalized estimating equation approach in SAS Proc Genmod, we estimate the relationship between CNA and licensed nursing staff, and facilities' total deficiency score and quality of care deficiency scores-calculated using the Centers for Medicare and Medicaid Services' Nursing Home Compare Five-Star Quality Rating System, which accounts for the complexity of the scope and severity of the cittions.
  
  
  RESULTS
  Our results confirmed that higher CNA staffing levels were predictors of lower total deficiency scores and quality of care deficiency scores after controlling for facility characteristics.
  
  
  CONCLUSIONS
  With a large sample size, repeated measure design, and advanced methods, we have found a relationship between CNA staffing and nursing home quality.
authors: Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL 33620, USA. khyer@usf.edu
authors: Kathryn
authors: K
authors: Hyer
authors: Kali S
authors: KS
authors: Thomas
authors: Laurence G
authors: LG
authors: Branch
authors: Jeffrey S
authors: JS
authors: Harman
authors: Christopher E
authors: CE
authors: Johnson
authors: Robert
authors: R
authors: Weech-Maldonado
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