A cross‐sectional study of implicit rationing of care in publicly funded nursing homes in Shanghai, China

Abstract

Aims: To investigate the level of implicit care rationing and its association with training needs in nursing homes in Shanghai, China.Background: Nursing homes in Shanghai are confronted with a lack of care resources. Implicit care rationing can emerge due to inadequate training of care workers.Methods: A cross-sectional survey was conducted between 10 September and 17 November 2020. A total of 374 care workers from 16 randomly were selected nursing homes from each of the administrative districts participated the surveys. The Basel Extent of Rationing of Nursing Care-Nursing Home instrument and the training needs analysis were adopted to measure implicit care rationing and training needs, respectively. Multiple regression techniques were used to explore the factors associated with implicit care rationing.Results: Activities related to social care, documentation and activation/rehabilitation (mean rating = 2.8, 1.89 and 1.93 respectively) were mostly likely to be rationed.Training needs of activities of daily living (ADL), activation/rehabilitation and documentation were significantly related to their implicit rationing (β = 0.864, 0.21 and 0.166, respectively, p < .01). Conclusion:Training needs are crucial determinants of implicit care rationing.Implications for nursing management: Quality control systems are needed to ensure care comprehensiveness. The current training system should be re-designed according to results of training needs analysis.implicit rationing of nursing care, missed care, training needs analysis, work environment | INTRODUCTIONWith the rapid expansion of the ageing population in China, the number of elderly people who require long-term care has been growing dramatically (Liu et al., 2020). Shanghai has the largest elderly population among all cities in China. By 2019, there were 3,616,600 people aged 65 and above in Shanghai, and the ageing rate was 24.6% (SRCA, 2019).To meet the growing needs of the elderly, a large amount of public funds has been allocated by the government in Shanghai to develop senior care services. By the end of 2019, there were 724 nursing homes with 151,600 aged-care beds, covering 2.9% of the elderly in Shanghai (SRCA, 2019). Among these institutions, 352 nursing homes (49.44%) and 81,100 aged-care beds (56.23%) were built with public funding, and thus, such nursing home services

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