For-profit and chain-affiliated operators, in particular, exhibited higher staffing variability, suggesting that operational consistency in staffing may carry measurable regulatory and reputational consequences.
Daily Variation in Nursing Home Staffing and Its Association With Quality Measures:
These findings highlight the importance of reporting daily variation in staffing to improve understanding of the relationship between staffing and quality. They suggest that 2 facilities with the same average staffing achieve different quality of resident care and survey ratings in association with the day-to-day variation in staffing. Measures of daily staffing may enhance the value of Nursing Home Care Compare for nursing homes and others engaged in quality improvement and consumers searching for high quality nursing homes.
Mukamel, Dana B., et al. “Daily Variation in Nursing Home Staffing and Its Association With Quality Measures.” JAMA Network Open, vol. 5, no. 3, 14 Mar. 2022, https://doi.org/10.1001/jamanetworkopen.2022.2051.
Daily Variation in Nursing Home Staffing Led to Poorer Clinical Quality:
Researchers found that only one-third of nursing homes would fall into the same quality decile for their average staffing and daily variation measures, indicating little agreement between the classifications. The remaining two-thirds of nursing homes fell into vastly different quality deciles when considering the two staffing measures. These findings suggest that variation measures can offer additional information beyond the traditional average staffing measure.
— RevCycle Intelligence, March 15, 2022
Why Staffing Ratios May Not Be the Best Way to Measure How Staffing Impacts Nursing Home Quality:
“What we are saying is if you use this new measure it actually gives you a different quality ranking for the nursing home. It’s not enough to just look at the average level, you also need to know how stable that average is. You can have two nursing homes with the same average level of staff and if one of them is not very unstable, that’s not a nursing home that provides the same good quality.”
— Skilled Nursing News, March 17, 2022
Instability In Staffing Levels at Nursing Homes Affects Quality of Care for Residents:
During low staffing days, when residents do not receive needed care, they are more likely to develop various conditions, such as pressure injuries, because staffing was not sufficient to rotate them in bed; exacerbation of wounds when staff is not available to change dressings in a timely fashion; falls with injuries without consistent daily attention to anticipating needs, such as requiring assistance in getting to the bathroom. Most of these consequences of short staffing cannot be fixed by additional staff on other days: more turning or toileting on extra-staffing days cannot eliminate the fall or the wound development that occurred when understaffed.
— Center for Medicare Advocacy, March 24, 2022
