Thesis

Staffing and Quality of Care in Nursing Homes

This literature review purports to analyze the factors affecting nursing homes' quality of care with a particular focus on staffing. The variables are analyzed based on Donabedian's Structure-Process-Outcome (SPO) framework. The inadequacy of staffing resources in nursing homes is one of the challenges of the federal government. Minimum staffing levels of 8 hours of care, among others, are set, but the nursing homes fail to meet them, resulting in poor resident outcomes. Nurse staffing levels per resident vary. This confirms the need to scrutinize the relationships between nursing staff and the quality of care and determine the barriers to providing optimal care in nursing homes. Medicaid is the biggest purchaser of nursing home care, but this is not perceived as a useful tool or solution more so that nursing homes rely on reimbursements to keep the operation afloat. Based on the literature review, Medicaid policies led to the limited availability of cash flow. When there is an overdependence on Medicaid reimbursements, this makes the nursing home operation not financially sustainable. The inadequacy of reimbursements and the period needed for these reimbursements are other Medicaid-related hindrances to operating optimally. They have compounding effects that cannot be addressed by merely addressing one issue at a time. The premise is that the lack of financial and human resources affects the quality of care. For instance, the literature review discovered that the nursing shortage affects the quality of nursing home care. California is one of the states in the US to receive the highest Medicaid reimbursement rates in their nursing homes. While this does not mean that all nursing homes in the country are profitable, the majority of the nursing homes are still Medicaid-dependent, and any reductions in payment rates will affect their operation. Nursing staff level and quality of nursing home care are directly correlational, and so higher nursing staff standards should improve care quality. Higher reimbursements allowed nursing homes to have greater resources to improve quality. However, the literature review discovered that extremely low staffing is a reality in nursing homes despite the government's strict staffing requirements. One reason is that nursing homes do not always follow those requirements. Enhancing the nursing homes' quality of care is, therefore, a federal concern wherein Medicaid reimbursements must consider the quality of care and adequacy of nursing staff. The literature review also found out that federal quality standards can be met if there are at least 4.1 hprd, which is adequate time to ensure that the residents receive quality care. Reimbursements must be seen as utilizable resources that can be used to increase staffing levels and minimize quality violations. The tier should be addressing Medicaid reimbursements first before addressing staffing and quality of care issues. However, the profit orientation of the nursing homes must be perceived as an operational hindrance as well. The literature review also discovered that the profit orientation of the nursing homes compels the management to forego hiring, which eventually leads to quality violations. This only goes to show that higher Medicaid funding can increase staffing which then leads to a higher quality of care in the nursing homes.

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