Multitasking in Nursing Homes: Differences Between For-Profit and Nonprofit Quality Outcomes

Nursing factors associated with length of stay and readmission rate of the elderly residents from nursing home based on LTCfocus database

OBJECTIVES

Nursing factors have been found to be associated with a reduction in readmission rates. Nevertheless, few attentions have been given to the effect of nursing factors on nursing home (NH) residents. This study was to assess the impact of nursing factors on the hospital readmissions and length of stay (LOS) of the elderly residents from the NH.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Data were extracted from the NH of the LTCFocus.org data set between 2011 and 2018. The study included residents aged ≥55 years who were admitted to NH in the United States, following a hospitalization event. The nursing factors included facility-level data elements and medical care personnel. An unsupervised machine learning algorithm (K-means) was used to cluster NH according to readmission rate and LOS. Multivariate logistic regression analysis was performed.

RESULTS

This study consisted of 107,000 NH-year observations. The median readmission rate was 17%, with a median LOS was 28.00 days. Three clusters were identified: cluster 1 was a high readmission rate with high LOS, cluster 2 was a low readmission rate with low LOS, and cluster 3 was a high readmission rate with low LOS. Multifacility and admission/bed were associated with a reduction in readmission rate and LOS in both cluster 1 vs cluster 2 and cluster 3 vs cluster 2. The special care unit and registered nurses' ratio were associated with decreased readmission rate and LOS in cluster 1 vs cluster 2. Total beds and Alzheimer unit decreased the readmission rate and LOS, whereas certified nursing assistant increased the readmission rate and LOS in cluster 3 vs cluster 2. NH for profit was associated with elevated readmission rate and LOS in cluster 1 vs cluster 2 and decreased readmission rate and LOS in cluster 3 vs cluster 2. Based on the subgroup analysis, the certified nursing assistant decreased readmission rate and LOS in cluster 1 vs cluster 2 and increased readmission rate and LOS in cluster 3 vs cluster 2 (all P < 0.005).

CONCLUSION

This study indicates the importance of the improvement of nurse number and level and the inputs of facility characteristics in NH.

The COVID-19 – related problems encountered by nursing homes in Poland and the steps undertaken to prevent disease spread in the first phase of the epidemic

Nursing Homes (NHs) are institutions of social assistance run by local governments or non-government organizations. Their purpose is to provide individuals with basic services. On March 20, 2020, the Regulation of the Minister of Health issued the declaration of the COVID-19 epidemic in Poland. The introduction of legal regulations allowed the authorities to take actions to prevent infections at NHs. The aim of the study was to analyze the COVID-19 – related problems encountered by nursing homes in Poland and the steps undertaken to prevent disease spread in the first phase of the epidemic.

The survey was conducted with use of an original questionnaire e-mailed to 532 NHs throughout Poland in May 2020. Results were analysed by way of the IBM SPSS Statistics program.

A total of 89 completed questionnaires were received from: 40 NHs organized by local government (44.9%), 24 run by churches (27.0%), 13 established by non-governmental organizations (14.6%) and 12 operating privately (13.5%). Among them, 78 NHs had less than 100 employees (87.6%) and 11 had more than 100 employees (12.4%), while 68 had up to 100 inhabitants (76.4%) and 21 had more than 100 inhabitants (23.6%). All NHs had problems with recruiting and retaining enough nursing staff.

The most commonly used method of COVID-19 spread prevention at NHs in the first phase of the pandemic was establishing an increased sanitary regime, monitoring of temperature of residents and staff members and preparing isolation rooms. The greatest problem was personnel shortages.