Gerontological Nursing Interventions Research Center (GNIRC)

Title: Nursing Staffing and Resident Outcomes in Nursing Homes
Principal Investigator: Nancy Ridenour, PhD, RN
Study Site: Illinois State University

Abstract
Despite tougher regulations and concerted efforts to improve the quality of care for older persons, concerns about nursing home quality continues. Policymakers implicate nursing staffing as a factor in falls, depression, bladder and bowel incontinence, and fecal impaction. While these outcomes clearly impact resident health, definitive nursing staffing guidelines cannot be recommended due to a paucity of research. The objective of this application is to complete the second phase of a two-phase project assessing the effects of nursing staffing on outcomes of residents. The central hypothesis of this study is that higher nursing staffing, both numbers and skill-mix, psoitively affects resident outcomes. We plan to test our central hypothesis by pursuing two specific aims:

1. Determine the total proportion of variance in falls, depression, bladder and bowel incontinence, and fecal impaction explained by the number of nursing staff hours per resident day, skill mix, resident risk factors, external and internal nursing home characteristics after the variance explained by internal resident characterists is removed.
2. Determine the unique proportion of variance in falls, depression, bladder and bowel incontinence, and fecal impaction explained by the number of nursing staff hours per resident day, skill mix, resident risk factors, external and internal nursing home characteristics.

This study will make a significant contribution to the state of the science of staffing on resident outcomes in nursing homes. Previously, only studies identifying outcomes have been published. This study will use risk adjustment to differentiate homes providing care for different types of residents. This study builds on a partnership between Illinois State University, University of Iowa, and University of Missouri to analyze LTC MDS data for a six-state region of the Centers for Medicare and Medicaid Services (CMS) and to provide information for policy makers on nursing staffing in nursing homes.