Nursing Effort and Quality in Long-Term Care Facilities

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DESCRIPTION (provided by applicant): The purpose of this study is to examine the relationship between nursing effort and quality of care for nursing home residents. This study uses extant data from time studies of nursing staff in three states and MDS data on the nursing home residents who were cared for by nurses in the time study to address the relationship between nursing effort and quality of care. Nursing effort is measured by the amount of minutes per day provided to each resident by nursing staff type (RN, LPN, aide, and other direct care staff'). The quality measures, which cover both care processes and outcomes, are derived from the MDS and they employ case-mix adjusted quality indicators that have been widely used in previous studies but without the case mix adjustment. Multi-level analysis, HLM, will be used to address the nesting of effects where residents are clustered within nursing units. This study represents a major advance over prior work. Nearly all previous research into staffing and care quality has relied on facility-level measures of staffing and quality. This study will allow for a much more fine-grained analysis of both unit and resident-level effects. The database consists of 3125 residents in 98 nursing units from 62 facilities. Results should shed light on the current policy debate over nursing home staffing standards.