Residents in nursing homes with insufficient staffing, high turnover of nurses, overuse of urinary catheters, and low rates of skin care appear to have more negative outcomes, according to a study sponsored by the Agency for Health Care Policy and Research (AHCPR).
After examining death rates, functional decline, and functional improvement over a 6month period for 2,500 Rhode Island nursing home residents, researchers found that when controlling for resident's health and functional status, those living in homes with low to moderate staff levels but high case mix were 30% to 40% less likely to improve, compared to patients in better staffed facilities. Patients also were less likely to improve in nursing homes with high turnover rates of registered nurses. Overall, death rates were only marginally affected by the nursing home characteristics studied.
The study found that some features of nursing homes are associated with improved patient function. For example, facilities that have high participation in organized activities seem to have better outcomes. Residents in facilities with high participation rates were only half as likely and one third less apt to suffer a decline in their functional ability than residents in nursing homes with more limited patient involvement. Similarly, persons in homes with moderate to high rates of skin care were twice as likely to improve as those in nursing homes with low rates of skin care. In contrast, residents in facilities that have extensive use of urinary catheters had double the likelihood of functional decline.
Researchers indicate that this study contributes to the understanding of which approaches to caring of nursing home residents are effective or detrimental and provides a foundation for new, innovative approaches to quality assurance and regulation.
For reprints of the study, contact AHCPR Publications Clearing house, PO Box 8547, Silver Spring, MD 20907; 800-358-9295.