Hendrix TJ, Foreman SE; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 195.
College of Nursing, University of Utah, 10 South 2000 East Room 211, Salt Lake City, UT 84112-5880, Phone: (801) 587-9666, E-mail: tjh152@psu.edu
RESEARCH OBJECTIVE: This study investigates the effect of nursing inputs on nursing home quality as measured by the prevalence of decubitus ulcers. The objective is to identify the most appropriate level of decubitus output at optimal cost. We answer the question of what nursing home staff optimal minimizes decubitus cost.STUDY DESIGN: Due to the large-sample properties and normal distribution of the sample, ordinary least squares (OLS) setimation gives unbiased and consistent results. To find optima we differentiate the model results for each of the staffing level coefficients, set the results equal to zero and solve for the optimal level of staffing.POPULATION STUDIED: The basic unit of analysis is the skilled nursing home in 1994. Through the use of the Online Survey Certification and Reporting System (OSCAR), we include 14,449 nursing homes.PRINCIPAL FINDINGS: The vast majority of nursing homes (n = 11,338) fall outside the optimal level (+/-5%) for decubitus costs. There are 4,811 facilities with greater than optimal (+5%) costs equaling $84,085,167. Another 6,427 have lower than optimal (-5%) costs equaling $83,230,463, for a total a societal welfare loss of $167,315,630. The results demonstrate that nursing assistants have substantially more impact than RNs on minimizing long-term care decubitus costs, but both are significant. However, increased LPN staffing does not move these costs toward a minimum. The model explains 46.4% of the decubitus variation and most variables are significant at very strong levels, including all of the impact staffing variables.CONCLUSIONS: This study advances our understanding of the relationship between nursing home staffing and outcomes. Prior studies have not addressed the question of optimal staffing based on outcome cost. Unlike these studies, the present inquiry indicates that more nurses (and aides) are good but only to a point -- and it indicates where that point lies. Unlike prior studies it addresses the question of how many nurses and aides are most efficient? Where, other studies have concluded that increasing numbers of nurses reduce bad outcomes, this study attempts to balance the additional cost of increasing nurse inputs with the cost savings resulting from fewer bad outcomes. This balance of cost and outcome leads to an estimate of an efficient optimum with respect to nursing home staffing inputs.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: In light of this inquiry, it is possible that the most efficient staffing model, at least to minimize the cost of decubitis in the long-term care setting, involves the exclusive use of RNs and NAs. By reducing LPN inputs, more NAs can be hired. This would increase the total number of workers available to turn, reposition, walk, bathe and feed long-term care residents. For many debilitating conditions (not just decubitis), these kinds of activities are important. Perhaps the study results suggest that increased RNs are needed in long-term care to function as direct supervisors and trainers of nursing assistants.PRIMARY FUNDING SOURCE: Optimal Nursing Home Staffing to Minimize Decubitus Ulcer CostsI received a small dissertation award ($500) from the Pennsylvamia State University College of Health and Human Development (Health Policy & Administration). Otherwise this study was self-funded
Publication Types:
Keywords:
- Costs and Cost Analysis
- Data Collection
- Health Policy
- Housing
- Humans
- Long-Term Care
- Nurses
- Nurses' Aides
- Nursing Homes
- Nursing Staff
- Personnel Selection
- Pressure Ulcer
- economics
- hsrmtgs
Other ID:
UI: 102273544
From Meeting Abstracts