The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes.

Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality

Cost-effectiveness of recommended nurse staffing levels for short-stay skilled nursing facility patients

BACKGROUND: Among patients in skilled nursing facilities for post-acute care, increased registered nurse, total licensed staff, and nurse assistant staffing is associated with a decreased rate of hospital transfer for selected diagnoses. However, the cost-effectiveness of increasing staffing to recommended levels is unknown. METHODS: Using a Markov cohort simulation, we estimated the incremental cost-effectiveness of recommended staffing versus median staffing in patients admitted to skilled nursing facilities for post-acute care. The outcomes of interest were life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness. RESULTS: The incremental cost-effectiveness of recommended staffing versus median staffing was $321,000 per discounted quality-adjusted life year gained. One-way sensitivity analyses demonstrated that the cost-effectiveness ratio was most sensitive to the likelihood of acute hospitalization from the nursing home. The cost-effectiveness ratio was also sensitive to the rapidity with which patients in the recommended staffing scenario recovered health-related quality of life as compared to the median staffing scenario. The cost-effectiveness ratio was not sensitive to other parameters. CONCLUSION: Adopting recommended nurse staffing for short-stay nursing home patients cannot be justified on the basis of decreased hospital transfer rates alone, except in facilities with high baseline hospital transfer rates. Increasing nurse staffing would be justified if health-related quality of life of nursing home patients improved substantially from greater nurse and nurse assistant presence

A quasi-experimental retrospective evaluation of a prison policy change

Interrupted time-series design and quasi-experimental logic were employed to assess the behavioral effects of a prison disciplinary intervention on a population of approximately 2000 adult male inmates. The uncontrolled nature of the prison environment prevented experimental analysis of intervention effects. The quasi-experimental methodology applied in this study exemplifies how data, otherwise lost, can be retrieved. In addition, the process by which qualified conclusions can be drawn from the retrieved data is demonstrated

The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes

National audienc

Article Commentary: The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes

Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality

The Nursing Home Physician Workforce

Unlike a number of other health care professions practicing in nursing homes (NH), data specific to physicians is almost nonexistent. The only nationally representative study of physician practice in the NH was completed almost a decade ago and could not account for response bias owing to the nonrandom nature of the survey methodology employed.1 Nonetheless, only 1 in 5 physicians engaged in primary care noted involvement in NHs and spent an average of only 2 hours per week in the facility. No information was available in this study pertaining to physician-patient ratios in the NH or the mix of activities engaged in by physician providers. Although NHs are required to provide staffing data on an ongoing basis through online survey and certification reporting (OSCAR), physician-specific data are suspect. Feng et al2 recently demonstrated the nongeneralizability of OSCAR-generated physician data when compared to information gleaned from an intensive survey of medical directors, directors of nurses, and administrators. In contrast, the nursing shortage in NHs has been confirmed by OSCAR and has provided the basis for new policy and program initiatives