Study Shows Weekend and Daily Variation in Nursing Home Staffing Led to Poorer Clinical Quality
Daily Variation in Nursing Home Staffing and Its Association With Quality Measures
Is daily variation in nursing home staffing associated with quality, and does it offer additional information to measures of average staffing levels? This quality improvement study of 13 339 nursing homes found that daily variation of staffing was significantly associated with the 5-Star Survey and Quality Measures rankings.
There was little agreement between the variation and the average staffing measures on quality decile rankings of nursing homes, suggesting that staffing variation provides new quality improvement information.
Mukamel DB, Saliba D, Ladd H, Konetzka RT. Daily Variation in Nursing Home Staffing and Its Association With Quality Measures. JAMA Netw Open. 2022;5(3):e222051. doi:10.1001/jamanetworkopen.2022.2051
Daily Variation in Nursing Home Staffing Led to Poorer Clinical Quality
Daily variation in nursing home staffing was associated with poorer clinical quality in Medicare and Medicaid-certified nursing homes, suggesting that reporting staffing variation could help provide new quality improvement information, according to a study published in JAMA Network Open.
Typically, nursing home quality regulations include minimum staffing standards to ensure that facilities provide residents with quality care. Meeting the average staffing level has been associated with better performance on process quality measures, on-site survey scores, and resident outcome measures.
Baily, Victoria. “Daily Variation in Nursing Home Staffing Led to Poorer Clinical Quality.” Revcycle Intelligence, 15 Mar. 2022, revcycleintelligence.com/news/daily-variation-in-nursing-home-staffing-led-to-poorer-clinical-quality.
Why Staffing Ratios May Not Be the Best Way to Measure How Staffing Impacts Nursing Home Quality
As the Biden administration looks to establish a minimum staffing requirement for the nursing home industry as part of its reform package, evidence suggests that measuring daily staffing variation may be just as important in understanding how staffing affects care quality.
That’s according to a study published in the JAMA Network Open this week looking at how daily staffing at nursing homes is associated with five-star quality measures.
What the study found was average staffing levels and minimum staffing standards do not fully capture the association of more staffing to better nursing home quality.
Zorn, Alex, and Alex Zorn. “Why Staffing Ratios May Not Be the Best Way to Measure How Staffing Impacts Nursing Home Quality.” Skilled Nursing News, Mar. 2022, skillednursingnews.com/2022/03/why-staffing-ratios-may-not-be-the-best-way-to-measure-how-staffing-impacts-nursing-home-quality.
Instability In Staffing Levels at Nursing Homes Affects Quality of Care for Residents
Nursing home staffing levels often decline on weekends. In November 2018, the Centers for Medicare & Medicaid Services (CMS) identified facilities with low staffing on weekends and directed states to conduct surveys in a portion of these facilities on weekends. Then, in January 2022, CMS began posting weekend nurse staffing levels at nursing homes, in addition to a single staffing measure, citing two reports by the Health and Human Services’ Office of Inspector General about the need for additional staffing information on the federal website Care Compare.
A new study confirms the importance of providing more detailed staffing information to the public. Analyzing staffing levels at 14,499 nursing facilities in 2017 and 2018, researchers found that daily variation in nurse staffing levels (registered nurses (RNs) and certified nurse assistants (CNAs)), which they describe as “instability of staffing levels,” negatively affects quality of care for residents. They note that although consumers recognize the importance of staffing hours in general, they may not understand that daily staffing variability is also associated with quality. They explain why:
Edelman, T. “Instability In Staffing Levels at Nursing Homes Affects Quality of Care for Residents.” Center for Medicare Advocacy, 23 Mar. 2022, medicareadvocacy.org/instability-in-staffing-levels-at-nursing-homes.