Agency Staffing and Nursing Home Quality

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DESCRIPTION (provided by the applicant): It is possible that much can be learned from examining the effect of workforce factors in nursing homes, given the almost intransigent low quality seen in many of these facilities. Although past research in this area has examined the effect of turnover and staffing levels on quality, there have been no studies that have examined the impact of agency staffing. In this research, we propose to examine the influence that agency staffing characteristics have on quality of care in a large sample of nursing homes. We believe that nursing home residents have increasingly more complex care needs, and facilities are using increasingly complex technology. Care is also dependent not only on how much is done, but upon what is done, how well it is done, when it is done, and by whom. Thus, simply adding more staff may be a necessary but not sufficient means of improving quality. Examining agency staffing may lead to broader policy debate over staffing issues rather than staffing levels in nursing homes. In preliminary analyses, we have identified use of agency staff as a significant influence on quality. In this project, we propose to extend this prior research, by using a larger sample, more refined measures of quality, and better specified staffing characteristic variables. We will merge data collected from a unique survey on turnover from 6,005 nursing homes with data from: the Minimum Data Set (MDS), the On-line Survey Certification and Recording (OSCAR) system, and the Area Research File (ARF). Staffing characteristics will come from the primary data, resident characteristics and quality indicators will come from the MDS, facility characteristics will come from the OSCAR, and market characteristics will come from the ARF. We will examine the associations between use of agency staff and quality, not only for licensed practical nurses (LPNs), and registered nurses (RNs), but also for nurse aides (NAs). PUBLIC HEALTH RELEVANCE: High turnover and absenteeism, combined with regulatory pressure to maintain minimum staff levels, has led to an increase in use of agency staff to cover staffing needs in nursing homes. Yet, little is known about this emerging practice and its impact on quality of care. This investigation examines use of agency staff and quality of care. Our results will have implications for policy makers, practitioners, and consumers.