A latent survival model integrated computer simulation-based evaluation for nursing home staffing

Abstract

Nursing homes (NHs) are critical facilities for caring frail older adults with around-the-clock formal care and personal assistance. To ensure quality of care for NH residents, an adequate staffing level is of great importance. Current NH staffing practice is mainly based on experience and regulation. The objective of this paper is to investigate the viability of experience-based and regulation-based strategies, as well as alternative staffing strategies to meet the heterogeneous service demand of NH residents at reduced labor cost under various scenarios of census compositions. We propose a predictive analytics integrated computer simulation model to characterize the heterogeneous service demand of NH residents, and further evaluate and identify promising staffing strategies at the facility level. Specifically, we propose a predictive model based on latent survival analysis to characterize diverse length-of-stay (LOS) with multiple discharge dispositions among NH residents. Further, we develop a simulation model with the incorporation of predictive analytics and domain knowledge to characterize the heterogeneous service demand of NH residents on different types of caregivers over time. Based on the simulation model, we develop a graphical user interface for the simulator to evaluate different staffing strategies at the facility level and inform NH administrators about promising strategies. We use real NH data to validate the proposed model and demonstrate its effectiveness. The proposed predictive LOS model considering multiple discharge dispositions exhibits superior prediction performance and offers better staffing decisions at reduced costs than those without the consideration. With the improved modeling fidelity via integrating predictive analytics with computer simulation, the proposed model is flexible to evaluate various staffing strategies using total labor cost as a performance metric, and can identify promising staffing strategies to meet the service demand of NH residents. Promising staffing strategies with the suggested staff-to-resident (SR) ratio can significantly reduce the total labor cost of multiple types of caregivers, as compared to the benchmark strategies, such as the SR ratios based on industrial practice or minimum requirement of state regulation. Moreover, we construct multiple scenarios of different census compositions of NH residents to demonstrate the capability of the proposed model. Our proposed model can facilitate NH staffing decision making to meet the heterogeneous service demand of NH residents at reduced labor costs.