New Staffing Data Source Can Improve Nursing Home Monitoring

Publicly available Long-term Care Facility Staffing Payroll-Based Journal (PBJ) staffing data have the potential to revolutionize efforts to monitor and study the key role of nursing home staffing, according to a report published in the July issue of Health Affairs.

Fangli Geng, from Harvard University in Cambridge, Massachusetts, and colleagues analyzed facility-level data from the PBJ (April 2017 to March 2018). Facility-reported staffing, resident census data, and annual inspection survey dates were also obtained from the Certification and Survey Provider Enhanced Reports (CASPER) for 2017 and 2018. Data from Nursing Home Compare (2018) were used to categorize facilities based on their organizational characteristics.

The researchers found that for each staffing type and across all ownership categories, the mean PBJ-reported hours per resident day were lower than those reported in CASPER. Staffing levels increased the week before the facilities' annual inspection surveys, reached a peak during the survey week, and then dropped following the survey. There were fluctuations in daily staffing with stable levels across staffing categories (registered nurse [RN], licensed practical nurse, and nurse aide) during weekdays, but there were drops on the weekends, especially for RN staffing. Comparing PBJ and Centers for Medicare and Medicaid Services-calculated expected staffing levels, for total staffing, 54 percent of facilities met the expected level less than 20 percent of the time.

"By offering a more objective and detailed characterization of nursing home staffing, PBJ data have several important strengths relative to facility-reported administrative data," the authors write. "These features will benefit public reporting, monitoring, and value-based purchasing efforts and, more generally, help advance understanding of how staffing potentially contributes to improved resident outcomes and quality of care."

Two authors disclosed financial ties to health care organizations.

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