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Relationship of Nursing Home Staffing to Quality of Care


  • John F. Schnelle,

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    • Address correspondence to John F. Schnelle, Ph.D., UCLA Borun Center, 7150 Tampa Avenue, Reseda, CA 91335. Dr. Schnelle, Sandra F. Simmons, Ph.D., and Barbara M. Bates-Jensen Ph.D., R.N., C.W.O.C.N., are with the University of California, Los Angeles, Department of Medicine, Division of Geriatrics, and the UCLA and Jewish Home for the Aging Borun Center for Gerontological Research, Reseda, CA. Additionally, Dr. Schnelle is with the Veterans Administration Greater Los Angeles Healthcare System; Sepulveda Geriatric Research, Education, and Clinical Center, Sepulveda, CA. Charlene Harrington, Ph.D., R.N., is with the University of California, San Francisco, School of Nursing. Mary Cadogan, R.N., Dr.PH., G.N.P., and Emily Garcia, B.A., are with the UCLA and Jewish Home for the Aging Borun Center for Gerontological Research, Reseda, CA. Additionally, Dr. Cadogan is with the UCLA School of Nursing.

  • Sandra F. Simmons,

  • Charlene Harrington,

  • Mary Cadogan,

  • Emily Garcia,

  • Barbara M. Bates-Jensen

  • Supported by a grant from the California HealthCare Foundation. The views expressed in this paper are those of the authors and may not reflect those of the Foundation. The California HealthCare Foundation, based in Oakland, California, is a nonprofit philanthropic organization whose mission is to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of the people of California. This research was also supported by grant AG10415 from the National Institute on Aging, UCLA Claude D. Pepper Older Americans Independence Center.


Objective. To compare nursing homes (NHs) that report different staffing statistics on quality of care.

Data Sources. Staffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes.

Study Design. Two groups of NHs (n=21) that reported significantly different and stable staffing data from all data sources were compared on quality of care measures.

Data Collection. Direct observation, resident and staff interview, and chart abstraction methods.

Principal Findings. Staff in the highest staffed homes (n=6), according to state cost reports, reported significantly lower resident care loads during onsite interviews across day and evening shifts (7.6 residents per nurse aide [NA]) compared to the remaining homes that reported between 9 to 10 residents per NA (n=15). The highest-staffed homes performed significantly better on 13 of 16 care processes implemented by NAs compared to lower-staffed homes.

Conclusion. The highest-staffed NHs reported significantly lower resident care loads on all staffing reports and provided better care than all other homes.