Nurse Staffing and Skill Mix Patterns in Relation to Resident Care Outcomes in US Nursing Homes

Yang, Bo; Carter, Mary; Trinkoff, Alison M.; Nelson, H. Wayne

doi:10.1016/j.jamda.2020.09.009

Cited by 26 publications

(36 citation statements)

References 25 publications

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“…However, the higher LPN staffing level without adequate RN or CNA staffing has been frequently linked to negative resident care outcomes in previous studies. 18 , 23 Thus, findings from this study suggest a complex interaction between market forces across the rural-urban divide and the availability of replacement staffing during the pandemic.…”

Section: Discussionmentioning

confidence: 72%

“…Inadequate NH staffing levels may lead to poor infection control, 4 higher confirmed COVID-19 cases, 24 , 25 and weakened NH capacity to provide essential ongoing care not directly related to COVID-19. 18 , 26 Our study findings that pre-pandemic staffing levels were negatively associated with NH's self-reported staffing shortages during the course of the pandemic re-emphasize the pressing need to address pre-existing rural-urban disparities in working conditions and workforce capacity in rural areas. Rural NHs should be more proactive and strategic about attracting direct care providers by providing competitive compensation, benefits, or incentives such as reduced training costs or loan repayment.…”

Section: Discussionmentioning

confidence: 78%

“…Plausibly, our findings suggest that rural NH human resource infrastructure capacity was less able to endure the prolonged caregiving intensity, which far exceeded normal demands, as the impact of the COVID-19 pandemic wore on and extending beyond one year. Pre-existing human and material resource deficits persistent in rural NHs, including inadequate pre-pandemic staffing-levels; 16 lower BSN educated RN staffing, 17 , 18 and the need for well-trained rural nursing personnel 19 , 20 may have exacerbated staffing shortages over time and in response to increasing workload related to COVID-19 infections.…”

Section: Discussionmentioning

confidence: 99%

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Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

2021

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The purpose of the study was to examine trends in COVID-19 cases, related deaths, and staffing shortages in nursing homes (NH) by rural and urban status from May 2020 to Feb 2021. Generalized linear mixed models with state-fixed effects were used to estimate the interaction effect of study period and rural/urban status on having at least: one COVID-19 case, one related death, and/or at least one week of staffing shortage using the NH COVID-19 data spanning the 40-week period. The findings revealed shortages in staff, particularly direct care providers, were greatly accelerated in rural NHs as the pandemic wore on over time. Conversely, staffing shortages in urban NHs were relatively stable despite the fluctuating COVID-19 cases over the same time period. The findings highlight the need of identifying effective strategies that prevent rural NHs from encountering staffing deficits in response to long-lasting natural disasters such as the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

2021

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“…Many Medicaid-dependent NHs lack outside revenue to maximize necessary services, such as staffing hours, 47 which are associated with increased hospitalizations. 48 Indeed, NHs with higher proportions of racial/ethnic minorities have reported lower registered nurse hours per resident day compared with NHs with lower proportions of racial/ethnic minorities. 49 Given the extensive knowledge on NH segregation, 45 it is critical for efforts aimed at reducing EOL care disparities to focus on Medicaid-dependent NHs.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Disparities in Nursing Home End-of-Life Care: A Systematic Review

Estrada

Agarwal

Stone

2021

Journal of the American Medical Directors Association

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Objective: Health disparities are pervasive in nursing homes (NHs), but disparities in NH end-of-life (EOL) care (ie, hospital transfers, place of death, hospice use, palliative care, advance care planning) have not been comprehensively synthesized. We aim to identify differences in NH EOL care for racial/ethnic minority residents. Design: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered in PROSPERO (CRD42020181792). Setting and Participants: Older NH residents who were terminally ill or approaching the EOL, including racial/ethnic minority NH residents. Methods: Three electronic databases were searched from 2010 to May 2020. Quality was assessed using the Newcastle-Ottawa Scale. Results: Eighteen articles were included, most (n ¼ 16) were good quality and most (n ¼ 15) used data through 2010. Studies varied in definitions and grouping of racial/ethnic minority residents. Four outcomes were identified: advance care planning (n ¼ 10), hospice (n ¼ 8), EOL hospitalizations (n ¼ 6), and pain management (n ¼ 1). Differences in EOL care were most apparent among NHs with higher proportions of Black residents. Racial/ethnic minority residents were less likely to complete advance directives. Although hospice use was mixed, Black residents were consistently less likely to use hospice before death. Hispanic and Black residents were more likely to experience an EOL hospitalization compared with non-Hispanic White residents. Racial/ethnic minority residents experienced worse pain and symptom management at the EOL; however, no articles studied specifics of palliative care (eg, spiritual care). Conclusions and Implications: This review identified NH health disparities in advance care planning, EOL hospitalizations, and pain management for racial/ethnic minority residents. Research is needed that uses recent data, reflective of current NH demographic trends. To help reduce EOL disparities, language services and cultural competency training for staff should be available in NHs with higher proportions of racial/ethnic minorities.

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“…Care is increasingly provided by PCWs, who comprise over 70% of the workforce (Mavromaras et al, 2017), a situation also reported in Canada (Song et al, 2020). However, evidence is mounting in Australia (Ludlow et al, 2021), and in comparable countries (Kim et al, 2014; Yang et al, 2021), of an association between staffing levels and skills mix, particularly higher RNs numbers, with increased quality of care for residents.…”

Section: Introductionmentioning

confidence: 99%

What factors influence nursing home use of hospital avoidance programs? An interview study

Rayner

Fetherstonhaugh

2021

Journal of Advanced Nursing

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Aims To understand why some nursing homes use hospital avoidance programs more frequently than others. Design Two hospital avoidance programs, called residential‐in‐reach services in Victoria, Australia, were evaluated using a qualitative descriptive design. Methods Between 2014 and 2018, 127 semi‐structured interviews were conducted with staff from nursing homes, general practitioners and staff from the residential‐in reach services. The interviews took an average of 45 min and transcripts were thematically analysed. Results Nursing home reliance on residential‐in‐reach services to manage deteriorating residents was evident in both evaluations. Irrespective of the model of service provision, reliance was associated with: the increased care needs of residents; difficulties accessing timely and appropriate medical care; and the reduced numbers of skilled registered nurses to assess and manage deteriorating residents. Conclusion The residential‐in‐reach services are highly regarded by nursing homes. However, some are reliant on these services to provide nursing assessment and management. Using residential‐in‐reach services to substitute for nursing care, deskills nurses and shifts the cost of providing care from the service provider to other agencies. To provide residents with quality nursing care, the number of skilled registered nurses able to work within their scope of practice needs to be increased in Australian nursing homes. Impact The findings highlight the challenges of providing care in older people living in aged care. Increasing the number of skilled registered nurses in Australian nursing homes, would support deteriorating residents to stay in familiar surroundings and reduce reliance on external services to provide nursing care.

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Nurse Staffing and Skill Mix Patterns in Relation to Resident Care Outcomes in US Nursing Homes

Cited by 26 publications

References 25 publications

Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

Racial/Ethnic Disparities in Nursing Home End-of-Life Care: A Systematic Review

What factors influence nursing home use of hospital avoidance programs? An interview study

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