Nursing home caregiver staffing levels and quality of care: A literature review

Journal of Applied Gerontology

Volumn 27, Issue 4, 2008, Pages 375-405

  Castle, Nicholas G ^a  

^a UNIVERSITY OF PITTSBURGH   (United States)

Author keywords

Nursing homes; Quality; Staffing

Indexed keywords

HEALTH CARE QUALITY; HUMAN; LAW; MEDICAL RESEARCH; MEDICAL STAFF; METHODOLOGY; NURSE; NURSING HOME; REVIEW; TRAINING;

EID: 48249115929     PISSN: 07334648     EISSN: 15524523     Source Type: Journal    
DOI: 10.1177/0733464808321596     Document Type: Review

References (89)

1. Akinci, F., & Krolikowski, D. (2005). Nurse staffing levels and quality of care in Northeastern Pennsylvania nursing homes. Applied Nursing Research, 18, 130-137.
2. Anderson, R.A., Hsieh, P.C., & Su, H.F. (1998). Resource allocation and resident outcomes in nursing homes: Comparisons between the best and worst. Research in Nursing and Health, 21 (4). 297-313.
3. Arling, G., Kane, R.L., Mueller, C., Bershadsky, J., & Degenholtz, H.B. (2007). Nursing effort and quality of care for nursing home residents. The Gerontologist, 47 (5). 672-682.
4. Arling, G., Karon, S.L., Sainfort, F., Zimmerman, D.R., & Ross, R. (1997). Risk adjustment of nursing home quality indicators. The Gerontologist, 37 (6). 757-766.
5. Barry, T., Brannon, D., & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. The Gerontologist, 45 (3). 309-317.
6. Bates-Jensen, B.M., Schnelle, J.F., Alessi, C.A., Al-Samarrai, N.R., & Levy-Storms, L. (2004). The effects of staffing on in-bed times of nursing home residents. Journal of the American Geriatrics Society, 52, 931-938.
7. Berlowitz, D.R., Anderson, J.J., Brandeis, G.H., Lehner, L.A., Brand, H.K., Ash, A.S., et al. (1999). Pressure ulcer development in the VA: Characteristics of nursing homes providing best care. American Journal of Medical Quality, 14 (1). 39-44.
8. Bliesmer, M., Smayling, M., Kane, R., & Shannon, I. (1998). The relationship between nursing staffing levels and nursing home outcomes. Journal of Aging and Health, 10 (3). 351-371.
9. Bostick, J.E. (2004). Relationship of nursing personnel and nursing home care quality. Journal of Nursing Care Quality, 19, 130-136.
10. Bowers, B.J., Esmond, S., & Jacobson, N. (2000). The relationship between staffing and quality in long-term care: Exploring the views of nurse aides. Journal of Nursing Care Quality, 14 (4). 55-64.
11. Brannon, D., Zinn, J.S., Mor, V., & Davis, J. (2002). An exploration of job, organizational, and environmental factors associated with high and low nursing assistant turnover. The Gerontologist, 42 (2). 159-168.
12. Carter, M.W., & Porell, F.W. (2003). Variations in hospitalization rates among nursing home residents: The role of facility and market attributes. The Gerontologist, 43 (2). 175-191.
13. Castle, N.G. (2000). Nursing homes increasing and decreasing restraint use. Medical Care, 38 (12). 1154-1163.
14. Castle, N.G. (2002). Nursing homes with persistent deficiency citations for physical restraint use. Medical Care, 40 (10). 868-878.
15. Castle, N.G. (2005). Administrators opinions of Nursing Home Compare. The Gerontologist, 45, 299-308.
16. Castle, N.G., & Banaszak-Holl, J.C. (2003). The effect of administrative resources on care in nursing homes. Journal of Applied Gerontology, 22 (3). 405-424.
17. Castle, N.G., & Engberg, J. (2005). Staff turnover and quality of care in nursing homes. Medical Care, 43 (6). 616-626.
18. Castle, N.G., & Engberg, J. (2006). Organizational characteristics associated with staff turnover in nursing homes. The Gerontologist, 46 (1). 62-73.
19. Castle, N.G., & Engberg, J. (2008). Nurse aide agency staffing and quality of care in nursing homes. Medical Care Research and Review, 65 (2). 232-52.
20. Castle, N.G., & Engberg, J. (in press). Further examination of the influence of caregiver staffing levels on nursing home quality. The Gerontologist.
21. Castle, N.G., & Fogel, B. (1998). Characteristics of nursing homes that are restraint free. The Gerontologist, 38 (2). 181-188.
22. Castle, N.G., Men, A., & Engberg, J. (2007). Variation in use of nursing home deficiency citations. Journal for Healthcare Quality, 29 (6). 12-23.
23. Castle, N.G. & Myers, S. (2006). Mental health care deficiency citations in nursing homes and caregiver staffing. Administration and Policy in Mental Health, 33 (2). 215-225.
24. Center for Medicare and Medicaid Services. (2000). Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes Phase I. Department of Health and Human Services. Available from http://cms.hhs.gov/medicaid/reports/rp1201home. asp
25. Center for Medicare and Medicaid Services. (2001). Report to Congress: Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes Phase II final report. Department of Health and Human Services. Available from Available from http://cms.hhs.gov/medicaid/reports/rp1201home.asp
26. Cohen, J.W., & Spector, W.D. (1996). The effect of Medicaid reimbursement on quality of care in nursing homes. Journal of Health Economics, 15 (1). 23-48.
27. Decker, F.H. (2006). Nursing staff and the outcomes of nursing home stays. Medical Care, 44, 812-821.
28. Decker, F.H., Dollard, J., & Kraditor, K.R. (2001). Staffing of nursing services in nursing homes: Present issues and prospects for the future. Senior Housing & Care Journal, 9 (1). 3-26.
29. Degenholtz, H.B., Kane, R.A., Kane, R.L., Bershadsky, B., & Kling, K.C. (2006). Predicting nursing facility residents' quality of life using external indicators. Health Services Research, 41 (2). 335-356.
30. Dellefield, M.E. (2000, June). Staffing in nursing homes and quality indicators: A literature review. Journal of Gerontological Nursing, pp. 17-28.
31. Dellefield, M.E. (2006). Organizational correlates of the risk-adjusted pressure ulcer prevalence and subsequent survey deficiency citation in California nursing homes. Research in Nursing & Health, 29, 345-358.
32. Donabedian, A. (1988). The quality of care. Journal of the American Medical Association, 260, 1743-1748.
33. Donoghue, C., & Castle, N.G. (2006). Voluntary and involuntary nursing home staff turnover. Research on Aging, 28, 454-472.
34. Dorr, D.A., Horn, S.D., & Smout, R.J. (2005). Cost analysis of nursing home registered nurse staffing times. Journal of the American Geriatrics Society, 53 (5). 840-845.
35. General Accounting Office. (1999). Nursing homes: Additional steps needed to strengthen enforcement of federal quality standards (GAO/HEHS-99-46). Washington, DC: Author.
36. Grabowski, D., & Castle, N.G. (2004). Persistent poor quality in nursing homes. Medical Care Research and Review, 61 (1). 89-115.
37. Harrington, C., Kovner, C., Kayser-Jones, J., Burger, S., Mohler, M., Burke, R., et al. (2000). Experts recommend minimum nurse staffing standards for nursing facilities in the United Sates. The Gerontologist, 40 (1). 1-12.
38. Harrington, C., & Swan, J.H. (2003). Nursing home staffing, turnover, and case mix. Medical Care Research and Review, 60 (3). 366-392.
39. Harrington, C., Zimmerman, D., Karon, S., Robinson, J., & Beutel, P. (2000). Nursing home staffing and its relationship to deficiencies. Journal of Gerontology: SOCIAL SCIENCES, 55B (5). S278 - S287.
40. Hendrix, T.J., & Foreman, S.E. (2001). Optimal long-term care nurse-staffing levels. Nursing Economics, 19 (4). 164-175.
41. Hickey, E.C., Young, G.J., Parker, V.A., Czarnowski, E.J., Saliba, D., & Berlowitz, D.R. (2005). The effects of changes in nursing home staffing on pressure ulcer rates. Journal of the American Medical Directors Association, 6, 50-53.
42. Hillmer, M.P., Wodchis, W.P., Gill, S.S., Anderson, G.M., & Rochon, P.A. (2005). Nursing home profit status and quality of care: Is there any evidence of an association ? Medical Care Research and Review, 62, 139-166.
43. Horn, S., Buerhaus, P., Bergstrom, N., & Smout, R. (2005). RN staffing time and outcomes of long-stay nursing home residents: Pressure ulcers and other adverse outcomes are less likely as RNs spend more time on direct patient care. American Journal of Nursing, 105 (11). 58-70.
44. Hughes, C.M., Lapane, K.L., & Mor, V. (2000). Influence of facility characteristics on use of antipsychotic medications in nursing homes. Medical Care, 38 (12). 1164-1173.
45. Hutt, E., Fredrickson, E., Ecord, M., & Kramer, A.M. (2003). Associations among processes and outcomes of care for Medicare nursing home residents with acute heart failure. Journal of the American Medical Directors Association, 4, 195-199.
46. Iezzoni, L.I. (1994). Risk adjustment for measuring health care outcomes. Ann Arbor, MI: Health Administration Press.
47. Institute of Medicine. (2001). Improving the quality of long-term care. Washington, DC: National Academy Press.
48. Intrator, O., Zinn, J., & Mor, V. (2004). Nursing home characteristics and potentially preventable hospitalizations of long-stay residents. Journal of the American Geriatrics Society, 52, 1730-1736.
49. Jette, D.U., Warren, R.L., & Wirtalla, C. (2004). Rehabilitation in skilled nursing facilities. American Journal of Physical Medicine & Rehabilitation, 83, 704-712.
50. Johnson, C.E., Dobalian, A., Burkhard, J., Hedgecock, D.K., & Harman, J. (2004 a). Factors predicting lawsuits against nursing homes in Florida 1997-2001. The Gerontologist, 44, 339-347.
51. Johnson, C.E., Dobalian, A., Burkhard, J., Hedgecock, D.K., & Harman, J. (2004 b). Predicting lawsuits against nursing homes in the United States 1997-2001. Health Service Research, 36 (9). 1713-1731.
52. Johnson, J., Cowles, C., & Simmens, S. (1996). Quality of care and nursing staff in nursing homes. In G. Wunderlich, F. Sloan, and C. Davis (Eds.), Nursing staff in hospitals and nursing homes: Is it adequate? (pp. 426-452). Washington, DC: National Academy Press.
53. Johnson-Pawlson, J., & Infeld, D. (1996). Nurse staffing and quality of care in nursing facilities. Journal of Gerontological Nursing, 22 (8). 36-45.
54. Kane, R.L. (2004). Commentary: Nursing home staffing-More is necessary but not necessarily sufficient. Health Services Research, 39 (2). 251-256.
55. Kash, B., Castle, N.G., & Hawes, K. (2006). Staff turnover and staffing levels in nursing homes. The Gerontologist, 46 (5). 609-619.
56. Kash, B.A., Hawes, K., & Phillips, C.D. (2007). Comparing staffing levels in the online survey certification and reporting (OSCAR) system with the Medicaid cost report data: Are differences systematic ? The Gerontologist, 47 (4). 480-489.
57. Kayser-Jones, J., Schell, E.S., Porter, C., Barbaccia, J.C., & Shaw, H. (1999). Factors contributing to dehydration in nursing homes: Inadequate staffing and lack of professional supervision. Journal of the American Geriatrics Society, 47, 1187-1194.
58. Kutner, J.S., Kramer, A.M., Mortimore, E.F., & Feuerberg, M.A. (1998, January). Hospitalization of nursing home residents: A qualitative study. Annals of Long-Term Care, pp. 1-7.
59. Lapane, K.L., & Hughes, C.M. (2004). Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes ? Medical Care, 42 (10). 992-1000.
60. Loeb, M.B., Craven, S., McGeer, A., Simor, A.E., Bradley, S.F., Low, D.E., et al. (2003). Risk factors for resistance to antimicrobial agents among nursing home residents. American Journal of Epidemiology, 157 (1). 40-47.
61. Mitchell, S.L., Kiely, D.K., & Gillick, M.R. (2003). Nursing home characteristics associated with tube feeding in advanced cognitive impairment. Journal of the American Geriatrics Society, 51, 75-79.
62. Mor, V. (2005). Improving the quality of long-term care with better information. Milbank Quarterly, 83, 1-20.
63. Moseley, C.B., & Jones, L. (2003). Registered nurse staffing and OBRA deficiencies in Nevada nursing facilities. Journal of Gerontological Nursing, 29 (3). 44-50.
64. Mueller, C., Arling, G., Kane, R., Bershadsky, J., Holland, D., & Joy, A. (2006). Nursing home staffing standards: Their relationship to nurse staffing levels. The Gerontologist, 46 (1). 74-80.
65. Mukamel, D.B., & Brower, C.A. (1997). The influence of risk adjustment methods on conclusions about quality of care in nursing homes based on outcome measures. The Gerontologist, 38 (6). 695-703.
66. Needleman J., Beurhaus, P.I., Mattke, S., Stewart, M., & Zelevinsky, K. (2001). Nurse staffing and patient outcomes in hospital. Final Report to the United States Department of Health and Human Services (Contract No. 230-99-0021). Washington, DC: Government Printing Office.
67. Omnibus Budget Reconciliation Act of 1987. P. L. 100-203. Subtitle C. The Nursing Home Reform Act. 42 U. S. C. 1395i-3(a)-(h)(Medicare); 1396r (a)-(h)(Medicaid).
68. Phillips, C.D., Hawes, C., Mor, V., Fries, B.E., Morris, J.N., & Nennstiel, M.N. (1996). Facility and area variation affecting the use of physical restraints in nursing homes. Medical Care, 34 (11). 1149-1162.
69. Porell, F., & Caro, F.G. (1998). Facility level outcome performance measures for nursing homes. The Gerontologist, 38 (6). 665-683.
70. Porell, F., Caro, F.G., Silva, A., & Monane, M. (1998). A longitudinal analysis of nursing home outcomes. Health Services Research, 33 (4). 835-865.
71. Ramsay, J.D., Sainfort, F., & Zimmerman, D. (1995). An empirical test of the structure, process, and outcome quality paradigm using resident-based, nursing facility assessment data. American Journal of Medical Quality, 10 (2). 63-75.
72. Rantz, M.J., Hicks, L., Grando, V., Petroski, G.F., Madsen, R.W., Mehr, D.R., et al. (2004). Nursing home quality, cost, staffing, and staff mix. The Gerontologist, 44, 24-38.
73. Rohrer, J.E., Momany, E.T., & Chang, W. (1993). Organizational predictors of outcomes of long-stay nursing home residents. Social Science & Medicine, 37, 549-554.
74. Schnelle, J.F., Simmons, S.F., Harrington, C., Cadogan, M., Garcia, E., & Bates-Jenson, B. (2004). Relationship of nursing home staffing to quality of care. Health Services Research, 39 (2). 255-250.
75. Simmons, S.F., Osterweil, D., & Schnelle, J.F. (2001). Improving food intake in nursing home residents with feeding assistance: A staffing analysis. Journal of Gerontology: MEDICAL SCIENCE, 56A (12). M790 - M794.
76. Spector, W., & Mukamel, D. (1998). Using outcomes to make inferences about nursing home quality. Evaluation and the Health Professions, 21 (3). 291-315.
77. Stevenson, D.G. (2005). Nursing home consumer complaints and their potential role in assessing quality of care. Medical Care, 43 (2). 102-111.
78. Stevenson, D.G. (2006). Nursing home consumer complaints and quality of care: A national view. Medical Care Research and Review, 63 (3). 347-368.
79. Straker, J. (1999). Reliability of OSCAR occupancy, census, and staff data: A comparison with the Ohio Department of Health Annual Survey of Long-Term Care Facilities (Technical Report Series 3-01). Oxford, OH: Scripps Gerontology Center.
80. Sullivan-Marx, E.M., Strumpf, N.E., Evans, L.K., Baumgarten, M., & Maislin, G. (1999 a). Initiation of continued physical restraint in nursing home residents following restraint reduction efforts. Research in Nursing & Health, 22, 369-379.
81. Sullivan-Marx, E.M., Strumpf, N.E., Evans, L.K., Baumgarten, M., & Maislin, G. (1999 b). Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts. Journal of the American Geriatrics Society, 47 (3). 342-348.
82. Svarstad, B.L., & Mount, J.K. (2001). Chronic benzodiazepine use in nursing homes: Effects of federal guidelines, resident mix, and nurse staffing. Journal of the American Geriatrics Society, 49, 1673-1678.
83. Wan, T.T.H. (2003). Nursing care quality in nursing homes: Cross-sectional versus longitudinal analysis. Journal of Medical Systems, 27 (3). 283-295.
84. Wan, T.T.H., Zhang, N.J., & Unruh, L. (2006). Predictors of resident outcome improvement in nursing homes. Western Journal of Nursing Research, 28 (8). 974-993.
85. Weech-Maldonado, R., Neff, G., & Mor, V. (2004). The relationship between quality of care and financial performance in nursing homes. Journal of Health Care Finance, 29 (3). 48-60.
86. Wray, N., & Hollingsworth, J. (1997). Case-mix adjustment using administrative databases: A paradigm to guide future research. Medical Care Research and Review, 54 (3). 326-357.
87. Zhang, N., Unruh, L., Liu, R., & Wan, T. (2006). Minimum nurse staffing ratios for nursing homes. Nursing Economics, 24 (2). 78-85, 93.
88. Zhang, X., & Grabowski, D. (2004). Nursing home staffing and quality under the Nursing Home Reform Act. The Gerontologist, 44, 13-23.
89. Zimmerman, S., Gruber-Baldini, A.L., Hebel, J.R., Sloane, P.D., & Magaziner, J. (2002). Nursing home facility risk factors and hospitalization: Importance of registered nurse turnover, administration, and social factors. Journal of the American Geriatrics Society, 50, 1987-1995.