Nursing home staffing standards reduced severe deficiency citations, researchers find

New research supports that nursing home staffing levels correlate with better quality of care. But it points to a phenomenon fewer could have predicted: diminished registered nurse hours spent on direct care.

The research could shed new light on discussions over the relation of caregiver skill mix and outcomes in nursing homes.“[Mandatory] staffing regulations led to a reduction in severe deficiency citations and improvement in certain health conditions that required intensive nursing care,” but they had the unintended effect of lowering the mix of direct care nursing skill, according to the study published in Health Economics.

In fact, the standards caused many facilities to use fewer registered nurses relative to licensed practical nurses and nursing assistants, and reduce the absolute level of indirect care staff, wrote authors Min M. Chen, Ph.D., of the College of Business, Florida International University, Miami, and David C. Grabowski, Ph.D., of Harvard Medical School, Department of Health Care Policy.

The researchers based their findings on more than 45,000 nursing home-year observations from 1996 to 2006 in California, Ohio and “control states” where there are no minimum standards. Additional metrics included detailed information on nursing home characteristics, resident census, payment source and quality indicators measuring different dimensions of quality.

Chen and Grabowski stressed, however, that facilities that ranked in the bottom quartile for staffing prior to the new regulations were most likely to “increase LPNs and CNAs and substitute away from indirect care staff, and improve in quality.”

While many advocates and researchers maintain that higher caregiver-resident staffing ratios lead to better care, the idea is not universally accepted.