Time and Economic Cost of Constipation Care in Nursing Homes

Abstract

Objective Chronic constipation is a common disorder among residents in long-term care; yet the cost to the nursing home of constipation-related care is not known. The objective of this study was to quantify the nursing staff and supply-related cost of constipation care to nursing homes from the perspective of the nursing home. Design Prospective, observational time-and-motion design. Setting Two United States nursing homes. Participants A total of 59 nursing home residents with chronic constipation and nursing staff providing constipation care to them. Measurements Actual time to complete constipation care-related tasks was measured via stopwatch by trained observers, and the number and professional level (eg, staff nurse, CNA) of staff performing each task was recorded. Frequency of constipation care task data was obtained through 60-day retrospective medical chart review for each subject. Nurse wage rate data was obtained from the Nursing Home Salary and Benefits Report, a US-based national source. Resident and nursing home descriptive information was also collected. Results The average cost per task occurrence ranged from $0.72 for enema administration to $1.74 for oral medication administration. Average nursing staff costs per subject per year were $1577 for oral medication administration, $215 for dietary supplement administration, $39 for constipation assessment, $17 for suppository administration, and $6 for enema administration. Based on estimates of frequency of occurrence, the total annual labor and supply cost per long-term care resident with constipation was $2253. Conclusion Nursing staff performance of constipation care-related tasks is time consuming and costly in the long-term care setting. Chronic constipation is a common disorder among residents in long-term care; yet the cost to the nursing home of constipation-related care is not known. The objective of this study was to quantify the nursing staff and supply-related cost of constipation care to nursing homes from the perspective of the nursing home. Prospective, observational time-and-motion design. Two United States nursing homes. A total of 59 nursing home residents with chronic constipation and nursing staff providing constipation care to them. Actual time to complete constipation care-related tasks was measured via stopwatch by trained observers, and the number and professional level (eg, staff nurse, CNA) of staff performing each task was recorded. Frequency of constipation care task data was obtained through 60-day retrospective medical chart review for each subject. Nurse wage rate data was obtained from the Nursing Home Salary and Benefits Report, a US-based national source. Resident and nursing home descriptive information was also collected. The average cost per task occurrence ranged from $0.72 for enema administration to $1.74 for oral medication administration. Average nursing staff costs per subject per year were $1577 for oral medication administration, $215 for dietary supplement administration, $39 for constipation assessment, $17 for suppository administration, and $6 for enema administration. Based on estimates of frequency of occurrence, the total annual labor and supply cost per long-term care resident with constipation was $2253. Nursing staff performance of constipation care-related tasks is time consuming and costly in the long-term care setting.