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Caregivers ARE Quality in Long Term Care

Caregivers ARE Quality in Long Term Care. Christine T. Kovner, R.N., Ph.D. Division of Nursing, Steinhardt School of Education, NYU April 30, 2003. Total Nurse Staffing Hours per Resident per Day, 2001. Certified nurse aides (CNA)- 2.1 hours

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Caregivers ARE Quality in Long Term Care

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  1. Caregivers ARE Quality in Long Term Care Christine T. Kovner, R.N., Ph.D. Division of Nursing, Steinhardt School of Education, NYU April 30, 2003

  2. Total Nurse Staffing Hours per Resident per Day, 2001 • Certified nurse aides (CNA)- 2.1 hours • Licensed practical/vocational nurse (LPN/LVN) - 0.7 hours • Registered nurses (RN) – 0.7 hours • Only RN hours have increased from 0.4 hours per day in 1993, while acuity has increased Harrington from CMS OSCAR data

  3. Reported Staff Ratios on each Shift – Nursing Homes 2001 • 1 CNA to 11.8 Residents • 1 LVN/LPN to 34 Residents • 1 RN to 32 Residents Harrington from CMS OSCAR data

  4. Research Studies: Positive Relationship Between Licensed Nurses & Quality • Increased licensed nursing hours were related to improved functional ability and decreased probability of death • Facilities with higher nurse staffing levels have fewer deficiencies • Facilities with more RNs per LPN had fewer assessment deficiencies Bliesmer et al., 1998; Harrington et al., 2000; Moseley & Jones, 2003

  5. Research Studies: Positive Relationship Between Licensed Nurses & Quality • Nursing homes meeting HHS preferred minimum staffing levels had no violation that caused actual harm to patients • 68% of homes that did not meet HHS standards had such violations • Less than 2.0 hours of nurse aid care per nursing home resident were almost 4 times more likely to get pressure sores than those in nursing homes that provided more than 2 hours (Stark report, 2001); (DHHS Report to Congress: Appropriateness of Minimum Nursing Staffing Ratios in Nursing Homes, 12- 1 (Spring 2000).

  6. Medication Errors in Home Care for Patients 65 years and older • 1.4% of patients taking medications older adults should always avoid • 8.4% of patients taking medications rarely appropriate for older adults Kovner, Menezes, & Feldman, 2003; MEPS data from AHRQ

  7. Occupational Training Requirements Many believe minimum training for nursing assistants should be increased: • Nursing Assistants --75 hours • Manicurists -- 400 hours • Barber -- 1500 hours www.barbercosmo.ca.gov/

  8. Recommended Nursing Hours in NHs (direct and indirect) Harrington, C., Kovner, C., et al. (2000). Experts recommend minimum nurse staffing standards for nursing facilities in the U.S. The Gerontologist 40, 5-16.

  9. Geriatric Preparation • Less than <1% (21,500) of working RNs are certified in geriatrics • Fewer than 0.3% (333) of the 97,362 physician residents slots are for geriatrics • Only 0.3% (720) of 200,000 pharmacists have geriatric certification Kovner, C.T., Mezey, M., & Harrington, C. (2002).

  10. References Anderson, R. A., Hsieh, P., Su, H. (1998). Resource allocation and resident outcomes in nursing homes: Comparisons between the best and worst. Research in Nursing and Health, 21, 297-313. Kovner, C.T., Menezes, J. & Feldman, P. (2003). Paper in progress. Harrington, C., Kovner, C., Mezey, M., Kayser-Jones, J., Berger, S., Muhler, M., Reilly, K., Burice, R., Zimmerman, D. (2000). Experts recommend minimum nurse staffing standards for nursing facilities in the U.S. The Gerontologist 40, 5-16. Kovner, C.T., Mezey, M., & Harrington, C. (2002). Who cares for older adults? Workforce implications of an aging Society. Health Affairs 21(5), 78-89. Bliesmer, M. M., Smayling, M. , Kane, R. & Shannon, I. (1998) The relationship between nursing staffing levels and nursing home outcomes. Journal of Aging and Health, 10(3), 351-371. Harrington, C. Zimmerman, D., Karon, S. L., Robinson, J. & Beutel, P. (2000). Nursing home staffing and its relationship to deficiencies. Journal of Gerontology: Social Sciences, 55B(5), S278-S287. Linn, M. G., L. & Linn, B. A. (1977). Patient outcomes as a measure of quality of nursing home care. American Journal of Public Health. 67(4), 337-344. Nyman, J. A. (1988). Improving the quality of nursing home outcomes: Are adequacy or incentive-oriented policies more effective? Medical Care, 26(12), 1158-1171. Kayser-Jones, Wiener, C. L. & Barbaccia, J. C. (1989). Factors contributing to the hospitalization of nursing home residents. The Gerontologist, 29, 502-510. Spector, W. D., & Takada, H. A. (1991). Characteristics of nursing homes that affect resident outcomes. Journal of Aging and Health 3(4), 427-454. Cherry, R. L. (1991). Agents of nursing home quality of care: Ombudsman and staff ratios revised. The Gerontologist. 31, 302-308. Kayser-Jones, J. & Schell, E. (1997). The effect of staffing on the quality of care at mealtime. Nursing Outlook, 45(2), 64-72. Harrington, C., Carrillo, H., Thollaug, S., & Summers, P. (1999)Nursing facilties, staffing, residents, and facility deficiencies 1991-1997. (Report prepared for the Health Care Financing Administration. San Francisco: University of California.

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