School of Public Health

Quality of care in nursing homes

Demographic changes such as decreasing fertility and population aging have increased the pressure on care settings. Due to demographic trends, demand for residential long-term care (LTC) has increased, and older adults have entered LTC with increasingly complex care needs and closer to the end of life than ever before. However, staffing levels have not kept up with these increasing demands. In almost all OECD countries, the number of LTC workers per population has remained consistent or decreased since 2011 – and more than half of OECD countries report a shortage of LTC caregivers. Especially in acute care, evidence points to an association between care staffing and resident outcomes. However, this evidence is more limited in residential LTC. The reason for these complexities may be that the relationship between nurse staffing and quality of care could be moderated by organizational context factors. Better organizational context, such as supportive leadership, a collaborative work culture, or supportive care teams may interact with LTC staffing and mitigate the negative effects of lower nurse staffing.

Therefore, this project aims to identify and analyze interactions between nurse staffing and organizational context factors in residential LTC, and the effects of these interactions on resident outcomes. To understand these interactions the first step is to map which interactions between elements of organizational context and nurse staffing in LTC have been described in the literature and what LTC resident outcomes are influenced by these staffing-context interactions. Based on these results the next step of this project will be to conduct interaction analyses using resident data and organizational context data. In addition, configuration analysis will be conducted to identify which combinations of organizational factors in the facilities lead to better resident outcomes.

This project is situated within the Translating Research in Elder Care (TREC) program, an integrated KT (iKT) research program. The unique data availability looking at influences on quality of resident care and life, using data from residents and all levels of staff allows to make significant contributions to both scientific and practical working knowledge.

The findings of this project will significantly contribute to strategies for improving organizational effectiveness. Findings will strengthen system managers' ability to usefully modify LTC work settings and improve working conditions of frontline staff. Most importantly, this project will contribute to better quality of care and quality of life in LTC settings.

 

1. Choroschun K, Kennedy M, Hoben M. More than just staffing? Assessing evidence on the complex interplay among nurse staffing, other features of organisational context and resident outcomes in long-term care: a systematic review protocol. BMJ Open 2022;12:e061073. doi:10.1136/ bmjopen-2022-061073