Nursing staff and the outcomes of nursing home stays

Background: Findings on the relationship between nurse staffing and nursing home outcomes (eg, dying vs. discharges to the community) have been inconsistent. Although some studies show outcomes related to staffing ratios, others do not. Subjects in studies showing staffing effects may have been primarily short-stay residents and longer stays in studies showing no staffing effects. Outcomes affected by staffing may vary by short and longer stays. Objective: The effect of staffing by duration of stay has not been studied explicitly. The purpose of this study was to discern whether the effect of nursing staffing on discharge status varies between short and longer stays. Method: Data on discharges came from the 1999 National Nursing Home Survey (n = 6386). Models were constructed for short and longer stays applying multinomial logistic regression. Results: For stays less than 60 days, but not among longer stays, the probability of leaving the nursing home in recovered or stabilized condition increased, and that of dying decreased, with an increasing staffing ratio for registered nurses. Clinical condition was the major factor differentiating discharge status among short and longer stays. Conclusion: Results indicate a likely reason for past inconsistent findings on staffing. Staffing ratios may affect discharge disposition more among short stays. Some discharge dispositions, such as death, may not be the most relevant outcomes to study to discern how staffing affects the care provided to longer-stay residents. More research is warranted on how the sensitivity of outcomes to staffing ratios varies across short- and longer-stay residents.