title: Effect of increased nursing home hospice use on nursing assistant staffing.
abstract: BACKGROUND
  Since 1999, there has been a significant increase in hospice providers and hospice use in nursing homes. A 1997 Office of Inspector General (OIG) report warned of possible kickbacks, monetary and otherwise, that might be paid by hospices to nursing homes in exchange for referrals. One possible kickback mentioned in the report was nursing homes receiving additional staff hours at no cost, which could lead to decreases in nursing home staffing. The purpose of this study was to determine if changes in nursing home hospice volume were related to changes in certified nursing assistant (CNA) staffing.
  
  
  METHODS
  The study included free-standing nursing homes with at least 3 years of observation between 1999 and 2006, no fewer than five deaths in any year, and between 30 and 500 beds (n=10,759). We examined the longitudinal relationship between changing hospice volume and CNA minutes per resident day (MPRD), utilizing nursing home fixed-effects regression analysis and adjusting for resident case mix and changing organizational characteristics.
  
  
  RESULTS
  The introduction of hospice services in a nursing home did not result in statistically significant changes in CNA staffing. Instead, increases in hospice volume resulted in small increases in CNA staffing. Specifically, the addition of 1000 hospice days, in a given year, resulted in an additional 0.79 (95% confidence interval [CI] 0.373-1.211) CNA MPRD.
  
  
  CONCLUSIONS
  The proposition that nursing homes may be decreasing their staffing as a result of receiving additional hospice staff was not supported by this study and, in fact, nursing homes were found to only slightly increase CNA staffing with increasing hospice volume.
authors.affiliation: Center for Gerontology and Health Care Research, Warren Alpert Medical School, Brown University, Providence, Rhode Island 02912, USA. Denise_Tyler@Brown.edu
authors.forename: Denise A
authors.initials: DA
authors.lastname: Tyler
authors.forename: Natalie
authors.initials: N
authors.lastname: Leland
authors.forename: Michael
authors.initials: M
authors.lastname: Lepore
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
mesh_terms: D017051:Hospice Care / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D009728:Nursing Assistants / Q000706:statistics & numerical data / Q000639:trends*; D009735:Nursing Homes / Q000458:organization & administration / Q000639:trends*; D009740:Nursing Staff / Q000458:organization & administration / Q000639:trends*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data / Q000639:trends; D000078329:Workforce