Nurse Staffing and Resident Outcomes: National and State-Level Analyses

Objectives: I) To examine the relationship between nurse and nurse aide staffing levels and pressure sores in nursing homes. 2) To test the hypothesis that fewer staff hours would be associated with lower quality of care and therefore a higher number of sores. 3) To determine whether this relationship differs by state, given variation in quality of care, regulation, and monitoring. Study Setting: All nursing homes in the United States during 2000 (14,280 nursing homes in total). Data Sources: Data were drawn from the federal On-line Survey Certification System (OSCAR), a uniform database on all nursing facilities federally certified for Medicare and Medicaid that includes facility characteristics and staffing data reported by facilities themselves. Study Design: The study is a cross-sectional analysis where the unit of analysis is the nursing home and where a separate regression equation is estimated for each state. Key Findings: Fewer nursing aide hours were associated with more pressure ulcers in the United States as a whole, when controlling for specific patient and facility characteristics. At the state level, however, this relationship was significant in only four states. Fewer total nursing hours were not significantly associated with more pressure ulcers in the United States as a whole or in almost all states. Facilities that had a greater percentage of ambulatory residents had a smaller percentage of pressure ulcers per resident. Facilities that had a greater percentage of Medicare residents and those that were part of a chain had a greater percentage of pressure ulcers per resident, although the relationship between chain status and ulcers was not found within most individual states. Conclusions: Nursing aide hours and total nursing hours were not significant predictors of pressure ulcers in most states. At the national level, however, nursing aide hours alone were a significant predictor of pressure ulcers. Other important predictors of pressure ulcers at the national and state levels were resident mobility and Medicare status.