Staff Turnover Linked to Poor Patient Outcomes in LTCs

Two recent studies suggest that preventing staff turnover should be given greater emphasis in long-term care facilities (LTCs), Advanced Healthcare Network for Nurses reports. The studies examined the relationship between turnover of nursing staff and quality of care for nursing homes residents and found negative outcomes for patients in facilities with high turnover.

Published in December 2013, both studies were based on data from the 2004 National Nursing Home Survey. The first, "Are Nursing Home Survey Deficiencies Higher in Facilities with Greater Staff Turnover," found that turnover for both licensed nurses and certified nursing assistants (CNAs) were associated with problems in quality of care, qualify of life, and resident behavior deficiencies. The second study, "Turnover Staffing, Skill Mix, and Resident Outcomes in a National Sample of U.S. Nursing Homes," found a relationship between high turnover among CNAs and adverse patient outcomes such as pressure ulcers, urinary tract infections, and pain.

An INQRI study led by Robin Newhouse and Laura Morlock, published in the May 2013 issue of Medical Care, underscores the importance of nurse staffing in providing quality care. The researchers tested in 23 rural hospitals a quality collaborative intervention to improve care for heart failure patients. At the end of the study, the researchers found no quantitative difference between the intervention and control groups on implementation of the key measures. They did find that hospitals with lower turnover in nurse staffing implemented more of the measures. The researchers assert that the study speaks to the central role of nurses in quality improvement.

INQRI also looked at patient outcomes in LTCs in The Res-Care-AL Intervention Study.  Researchers, led by Barbara Resnick and Sheryl Zimmerman, conducted a randomized controlled trial to test Function Focused Care – Assisted Living, an intervention designed to maintain and improve function, physical activity, muscle strength, psychosocial outcomes, and decrease adverse events (pain, falls, and hospitalizations) among assisted living residents.

How Will the ACA Effect Long-Term Care?

In a new Health Affairs article (supported by the Commonwealth Fund), Naylor, Kurtzman, Grabowski, et al., analyze and provide policy recommendations for three provisions of the Affordable Care Act focusing on the promotion of transitional care programs. The authors suggest that additional attention is needed to ensure that unintended consequences resulting from these three provisions are adequately anticipated for in order to ensure vulnerable older adults utilizing long-term services receive the support they require. 

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Nursing homes: A Caring Staff Makes All The Difference

Earlier today, Robin Erb and Kristi Tanner, of the Detroit Free Press, published the final article of their three piece series focusing on the quality of care in nursing homes. The article gave a personalized view of how caring, compassionate staff can positively effect the quality of life experienced by nursing homes' residents.

Click here to read the article.

Click here to read the first article in the series.

Click here to read the second article in the series.

Publish Post

Skilled Nursing and Post-Acute Care Has Improved in 9 of 10 Quality Areas

Last week, the Alliance for Quality Nursing Home Care and American Health Care Association, released their annual report that showed America's nursing facilities are continuing to build upon quality improvements reported in previous years, including measurable improvements in nine out of 10 quality measures since 2009. In the past year, nursing facilities have improved in all short-stay measures, which include patient delirium, pain and pressure ulcers, and a vast majority of long-stay measures including measureable improvements in activities of daily living (ADL), high-risk pressure ulcers, resident mobility and pain. It should also be noted that INQRI program leader, Mary D. Naylor, Ph.D., RN, FAAN, and her team at the University of Pennsylvania, greatly contributed to the findings in this report.

Click here to read the full press release.

Click here to access the full report (in e-book format).

AHRQ Innovations Exchange - Long Term Care

Check out today's edition of the AHRQ Innovations Exchange, highlighting issues in long term care.

A few highlights:

• Interdisciplinary Team Identifies and Addresses Risk Factors For Falls Among Nursing Home Residents, Leading to Fewer Falls and Less Use of Restraints
• Nurse-Led Program Increases Provision of Cessation Counseling to Inpatients Who Smoke
• Nursing Home Learning Collaborative Improves Quality of Care, Reduces Staff Turnover

INQRI's Connection to Long Term Care

Although much of our work is focused on acute care settings, in the last couple of years, INQRI has expanded to other health care settings. To that end, we are very interested in the issues surrounding long term care.

"The Res-Care-AL Intervention Study" is a randomized controlled trial to test a restorative care intervention for assisted living (AL). The project incorporates patient centered outcomes (falls); nursing centered outcomes (restorative care services); and system-centered outcomes (staff turnover) as designated by the National Quality Forum. The primary aim of this study is to maintain or improve the residents' physical activity, physical status, function, and length of stay in the facility. The secondary aim related to residents focuses on mood, life satisfaction, resilience, self-efficacy and outcome expectations, social-support for exercise, and person-environment fit. This team is co-led by Barbara Resnick, PhD, CRNP, a nurse researcher, and Sheryl Zimmerman, PhD, MSW, a social worker.

Click here to check out an update on the project.

As previously mentioned in this blog, our program director, Mary Naylor is the Marian S. Ware Professor in Gerontology at the University of Pennsylvania. She is passionate about ensuring that top quality care is delivered across settings. Click here to learn about Dr. Naylor's transitional care model.