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Caregiver Staffing in Nursing Homes and Their Influence on Quality of Care: Using Dynamic Panel Estimation Methods

Castle, Nicholas G. PhD*; Anderson, Ruth A. RN, PhD, FAAN

doi: 10.1097/MLR.0b013e31820fbca9
Original Articles

Background There is inconclusive evidence that nursing home caregiver staffing characteristics influence quality of care. In this research, the relationship of caregiver staffing levels, turnover, agency use, and professional staff mix with quality is further examined using a longitudinal analysis to overcome weaknesses of earlier research.

Methods The data used came from a survey of nursing home administrators, Nursing Home Compare, the Online Survey Certification and Reporting data, and the Area Resource File. The staffing variables of Registered Nurses, Licensed Practical Nurses, and Nurse Aides were measured quarterly from 2003 through 2007, and came from 2839 facilities. Generalized method of moments estimation was used to examine the effects of changes in staffing characteristics on changes in 4 quality measures (physical restraint use, catheter use, pain management, and pressure sores).

Results Regression analyses show a robust association between the staffing characteristic variables and quality indicators. A change to more favorable staffing is generally associated with a change to better quality.

Conclusions With longitudinal information and quarterly staffing information, we are able to show that for many nursing homes improving staffing characteristics will improve quality of care.

*Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

Virginia Stone Professor of Nursing, Duke University School of Nursing, Durham, NC

Reprints: Nicholas G. Castle, PhD, Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, A610 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.