Characteristics of Nursing Homes that Affect Resident Outcomes

TLDR

Although interest in using outcomes as quality measures has risen, few studies have linked structure or process to outcomes. This analysis of about 2,500 residents in 80 Rhode Island nursing homes estimates which care aspects associate with resident outcomes while controlling for resident characteristics. Outcomes over a six‑month period included death, functional decline, and functional improvement. Higher staff levels and lower RN turnover were linked to functional improvement, while high catheter use, low skin‑care rates, low activity participation, and few private‑pay residents predicted poorer outcomes; surprisingly, receipt of a serious federal citation was associated with better outcomes, and for‑profit facilities appeared more resource‑efficient.

Abstract

Although there has been increased interest in using outcomes as measures of quality, few studies have shown a link between structure or process and outcomes. In this analysis, based on approximately 2,500 residents in 80 nursing homes in Rhode Island, multivariate models estimate which aspects of care are associated with resident outcomes after controlling for resident characteristics. Outcomes, measured over a 6-month period included death, functional decline, and functional improvement. Results suggest that higher staff levels and lower RN turnover were related to functional improvement. Facilities with high catheter use, low rates of skin care, and low participation in organized activities were associated with negative outcomes. Facilities with few private-pay residents were also associated with negative outcomes. Receipt of a serious federal citation was associated with improved outcomes. For-profit facilities appeared to be more efficient in use of resources.