| This study investigates how nurse staffing affect quality of life (QOL) and quality of care (COC) for nursing home residents. The main independent variables are: (1) nursing-staffto-resident ratios; and (2) extent of nursing pool use. The staff ratios are calculated separately for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs). Pool use was calculated separately for licensed personnel (RN + LPN) and CNAs. Control variables are ownership, financial constraint constructed by percentage of Medicaid residents and occupancy rate, administrative personnel including administrator and director of nursing tenure, and (for QOL) activity-personnel-to-resident ratios. QOL is defined as outcomes on 10 psychosocial domains, which were case-mix adjusted. QOC was defined as 20 selected quality indicators (QIs), which were risk-adjusted for greater clinical sensitivity.;The study used four sources of data: (1) personal interviews with nursing home residents collected for a national CMS study; (2) Minimum Data Sets for the same nursing home residents for one year prior to the QOL measurement; (3) the On-Line Survey and Certification Assessment Review data for staffing levels; and (4) administrative questionnaires developed for this dissertation for stability and pool use. The sample consists of around 2,800 residents in 100 nursing homes in 6 states.;Latent Variable Structural Equation Modeling method with bootstrap techniques was used to analyze impact of all factors mentioned above on QOL and QOC simultaneously. The results from this study indicate that nursing staff level positively and significantly affects QOL. Among different types of nursing staff, RN plays a major role in nursing staff level construction and has the greatest positive impact on residents' QOL. Pool use negatively affects QOL, but it is not statistically significant. However, no statistical significant relationships could be identified between nursing staff level and QOC. Regardless of whether QOL and QOC is the dependent variable, findings show almost identical relationships among financial constraints, administrative stability, ownership, and nursing staff level. Administrative stability ownership (non-profit) positively affects nursing staff level. Financial constraint negatively affects nursing staff level. Indirect effects from these factors on QOL were also identified, but no effects were identified on QOC. |
