National Nursing Home Survey Research Articles

ADDRESSING SOCIAL ISOLATION IN NURSING HOMES DURING COVID-19 – QUALITATIVE DATA FROM A NATIONAL SURVEY

Abstract The COVID-19 pandemic had dramatic, sometimes devastating impacts on nursing homes, residents, and staff. Rapid deployment of innovative approaches to resident care was required even while under sustained distress. We collected textual responses to open-ended questions about COVID-19 experiences through a national nursing home survey of Directors of Nursing/Administrators in February-May 2022. We employed a stratified (by size and quality ratings) sample of 1,669 nursing homes. Response rate was 30%, and 51% of responders answered > 1 open-ended question. We conducted an iterative thematic qualitative analysis yielding 10 themes. Respondents described addressing social isolation using new technology; enlisting staff from across the nursing home [beyond-the-call effort, gifting of voluntary time], and new ways for residents to safely connect with family. Respondents felt severely limited by COVID regulations that seemed to ignore residents’ mental health needs. The majority of respondents felt significant professional and personal impact of the pandemic experience: “The pandemic was the most stressful situation I have encountered in 26 years of nursing” – “What a toll it took on all us emotionally, physically, and mentality” – “Every day was a challenge and I felt hopeless” – Some respondents plan to quit: “I am now seeking other employment. It has been too much for too long and has directly affected my mental health.” Nursing homes reported extraordinary efforts put forth by administration and staff to meet the needs of residents. Efforts to retain nursing staff are needed given profound impacts of the pandemic on their personal and professional lives.

Organizational readiness to change as a leverage point for improving safety: a national nursing home survey

BackgroundA stronger safety climate in nursing homes may reduce avoidable adverse events. Yet efforts to strengthen safety climate may fail if nursing homes are not ready to change. To inform improvement efforts, we examined the link between organizational readiness to change and safety climate.MethodsSeven safety climate domains and organizational readiness to change were measured with validated Community Living Center/CLC Employee Survey of Attitudes about Resident Safety and Organizational Readiness to Change Assessment. Safety climate domains comprised of safety priorities, supervisor commitment to safety, senior management commitment to safety, safety attitudes, environmental safety, coworker interactions around safety, and global rating of CLC. We specified models with and without readiness to change to explain CLC- and person-level variance in safety climate domains.ResultsOne thousand three hundred ninety seven workers (frontline staff and managers) responded from 56 US Veterans Health Administration CLCs located throughout the US. Adding readiness to change reduced baseline CLC-level variance of outcomes (2.3–9.3%) by > 70% for interpersonal domains (co-workers, supervisors, and senior management). Readiness to change explained person-level variance of every safety climate domain (P < 0.05), especially for interpersonal domains.ConclusionsOrganizational readiness to change predicted safety climate. Safety climate initiatives that address readiness to change among frontline staff and managers may be more likely to succeed and eventually increase resident safety.

Changes in US Nursing Home Infection Prevention and Control Programs From 2014 to 2018

ObjectiveBurgeoning rates of antibiotic resistance have resulted in a shift in national focus to improve infection prevention and control programs in US nursing homes (NHs). We sought to evaluate the changes in nursing home infection prevention and control programs over time. DesignRetrospective comparative analysis of national nursing home survey data from 2014 and 2018. Setting and participantsWe used survey data from 2 nationally representative samples of US nursing homes (945 NHs in 2014 and 888 in 2018). MethodsThree indices measuring antibiotic stewardship, outbreak control, and urinary tract infection prevention (ranging from 0 to 100) were developed to measure the change in infection prevention and control programs. Multivariable linear regression models were used to identify facility and infection preventionist characteristics associated with each index. Decomposition models were used to identify contributions of factors on the differences in each index over time. ResultsFrom 2014 to 2018, we saw strengthening of antibiotic stewardship practices by 33 percentage points, outbreak control practices by 13 percentage points, and urinary tract infection prevention practices by 6 percentage points. Although we found several predictors of these improvements, much of the improvement was due to the difference in time. Conclusions and ImplicationsPolicy mandates and greater national attention are likely important factors in improving nursing home infection prevention and control practices. Further work is needed to evaluate the effect of these programs on resident outcomes.

Trend Change in the Intellectual Disability Nursing Home Census From 1977 to 2004.

The Omnibus Budget Reconciliation Act (OBRA) of 1987 was expected to reduce inappropriate residential placements of persons with intellectual disability (ID) in nursing homes. Utilizing the nationally representative 1977, 1985, 1995, and 2004 National Nursing Home Surveys (NNHS), we estimate trend change in the ID nursing home census pre- and post-OBRA. We find a marked decrease in number and percentage, and a shift in the age distribution of the ID nursing home census, most pronounced between 1985 and 1995. We contend that these trend changes, concurrent with growth in the overall nursing home population, provide empirical evidence that policy changes that occurred during the OBRA enactment period were successful in reducing inappropriate residential placements of persons with ID in nursing homes.

Thirty-Year Trends in Nursing Home Composition and Quality Since the Passage of the Omnibus Reconciliation Act

ObjectiveIn 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home (NH) quality assurance system. This study examines trends in facility, resident, and quality characteristics since passage of that legislation. MethodsWe conducted univariate analyses of national data on US NHs from 3 sources: (1) the 1985 National Nursing Home Survey (NNHS), (2) the 1992-2015 Online Survey Certification and Reporting (OSCAR) Data, and (3) LTCfocUS data for 2000-2015. We examined changes in NH characteristics, resident composition, and quality. Setting and participantsUS NH facilities and residents between 1985 and 2015. ResultsThe proportion of NHs that are Medicare and Medicaid certified, members of chains, and operating not-for-profit has increased over the past 30 years. There have also been reductions in occupancy and increases in the share of residents who are racial or ethnic minorities, admitted for post-acute care, in need of physical assistance with daily activities, primarily supported by Medicare, and diagnosed with a psychiatric condition such as schizophrenia. With regard to NH quality, direct care staffing levels have increased. The proportion of residents physically restrained has decreased dramatically, coupled with changes in inappropriate antipsychotic (chemical restraint) use. Conclusions and implicationsTogether with changes in the long-term care market, the NHs of today look very different from NHs 30 years ago. The 30th anniversary of OBRA provides a unique opportunity to reflect, consider what we have learned, and think about the future of this and other sectors of long-term care.

Diabetes diagnosis and management among insured adults across metropolitan areas in the U.S.

This study provides diabetes-related metrics for the 50 largest metropolitan areas in the U.S. in 2012—including prevalence of diagnosed and undiagnosed diabetes, insurance status of the population with diabetes, diabetes medication use, and prevalence of poorly controlled diabetes.Diabetes prevalence estimates were calculated using cross-sectional data combining the Behavioral Risk Factor Surveillance System, American Community Survey, National Nursing Home Survey, Census population files, and National Health and Nutrition Examination Survey. Analysis of medical claims files (2012 de-identified Normative Health Information database, 2011 Medicare Standard Analytical Files, and 2008 Medicaid Analytic eXtract) produced information on treatment and poorly controlled diabetes by geographic location, insurance type, sex, and age group.Among insured adults with diagnosed type 2 diabetes in 2012, the proportion receiving diabetes medications ranged from 83% in Oklahoma City, Oklahoma, to 65% in West Palm Beach, Florida. The proportion of treated patients with medical claims indicating poorly controlled diabetes was lowest in Minneapolis, Minnesota (36%) and highest in Texas metropolitan areas of Austin (51%), San Antonio (51%), and Houston (50%).Estimates of diabetes detection and management across metropolitan areas often differ from state and national estimates. Local metrics of diabetes management can be helpful for tracking improvements in communities over time.

Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey.

This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. Data from 2,034 nursing home administrators from a 2009/2010 national nursing home survey and ordered logistic regression were used. After adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44% greater likelihood of having higher CNA retention (odds ratio [OR] = 1.44; 95% confidence interval [CI] = [1.15, 1.81], p = .001) and those with high empowerment scores had a 64% greater likelihood of having higher CNA retention (OR = 1.64; 95% CI = [1.34, 2.00], p < 001). Greater opportunities for CNA empowerment are associated with longer CNA retention. This research suggests that staffing empowerment practices on the whole are worthwhile from the CNA staffing stability perspective.

Functional Status of Elderly Nursing Home Residents With Parkinson's Disease.

Parkinson's disease (PD) is a debilitating neurological disorder that has a significant impact on activities of daily living (ADL). Limited data exists regarding the functional status of nursing home residents with PD. The study examined the nature, extent, and predictors of limitation of ADL in patients with PD residing in nursing homes. This study used cross-sectional design involving data from the National Nursing Home Survey (NNHS). The dependent variable was the total number of ADL for which the patient needed assistance. Assistance for ADL comprised of five items of transferring, dressing, eating, toileting and bathing. Multivariable linear regression was used to examine the individual, biological and environmental factors associated with assistance needed for ADL. The nationally representative study sample was of 98,093 nursing home residents with PD for an overall prevalence of 6.57%. The mean age of the study sample was 81.03±0.34 years. Mood symptoms (45%), behavioral symptoms (24%)and dementia (8%) were common among PD patients. Assistance needed for each ADL ranged from 68.24% for eating to 99.25% for bathing. Older age, being married, living in metropolitan statistical area (MSA), living in other place prior to admission, and presence of mood symptoms were positively related to assistance for ADL. Presence of behavioral symptoms and use of levodopa combination therapy were negatively related to assistance for ADL. Majority of the nursing home residents with PD had disability in all the five items of ADL. Various individual, environmental and biological factors were associated with ADL in nursing home residents with PD.

PHP70 - PROJECTING THE BURDEN OF CHRONIC DISEASES IN THE UNITED STATES FROM 2016 TO 2025 UNDER DIFFERENT SCENARIOS USING A MICROSIMULATION APPROACH

Chronic diseases impose significant financial and health burdens on the society. The aim of this study is to project the health and financial burdens of chronic diseases from societal and employer perspectives until 2025, and estimate the potential benefits of population health initiatives and medical advancements. The baseline population was synthesized from large national survey databases including National Health and Nutrition Examination Survey (NHANES), American Community Survey (ACS), Behavioral Risk Factor Surveillance System (BRFSS), and National Nursing Home Survey (NNHS) using a propensity matching algorithm. A microsimulation model was constructed in SAS to simulate the prevalence, incidence, progression, and potential treatment effects of more than 10 chronic diseases including asthma, COPD, osteoporosis, cancers, diabetes, hypertension, stroke, and other cardiovascular diseases. Each individual’s demographics, biometrics, diagnosis and treatment status, and health history were used to predict disease incidence, progression, and mortality based on published clinical evidence. The baseline scenario assumes current population behavior and treatment states continue into the future. The ‘optimistic’ scenario assumes more people quit smoking and drinking, more physically active population, higher treatment adherence, timely diagnosis, slower cost growth, and insurance coverage expansion. If current trends continue, chronic diseases will result in 1.4 trillion in direct medical costs and 802 million work days in absenteeism in 2025. In the same year 210 million people will have at least 1 chronic disease. Treating the chronic conditions will consume 35 cents out of every dollar spent on healthcare in the following 10 years. The ‘optimistic’ scenario would result in 51 million fewer diagnoses and 780 billion in total direct medical cost savings by 2025. Costs associated with chronic diseases constitute a significant portion of all healthcare spending. Investing in population health initiatives could effectively reduce the burden 10 years from now.

Prevalence, Patterns and Predictors of Psychotropic Polypharmacy Among Elderly Individuals with Parkinson's Disease In Long Term Care Settings In The United States.

Elderly individuals with Parkinson's disease (PD) generally suffer from more than one psychiatric comorbidity, which necessitates the use of concurrent psychotropic medications. To the best of the author's knowledge there are no nationally representative estimates of psychotropic polypharmacy among elderly individuals with PD in the United States (US). Therefore, the primary objective of this study was to examine the prevalence, patterns and predictors of psychotropic polypharmacy among elderly individuals with PD in the (US). A retrospective, cross-sectional study design with 2004 National Nursing Home Survey (NNHS) and 2007 National Home and Hospice Care Survey (NHHCS) data was used. The analytic sample included elderly (age ≥65 years) individuals with PD. Antidepressants, antipsychotics, sedative/hypnotics, and anti-anxiety medications constituted the psychotropic medication classes. Concurrent use of two or more psychotropic medications was classified as psychotropic polypharmacy. Approximately 93,648 and 37,439 elderly individuals with PD resided in nursing homes and home health settings respectively. Among elderly nursing home residents with PD, the nationally representative prevalence of psychotropic polypharmacy was 26.28%, whereas, it was 21.36% in the home health setting. Use of antidepressant medications constituted the majority of the psychotropic medication use among both nursing home (48.91%) and home health (40.98%) residents with PD. Multiple logistic regression analyses revealed that specific comorbidities were significantly associated with psychotropic polypharmacy among elderly nursing home residents with PD. These findings underscore the importance of evidence-based prescribing when psychotropic medications are used in elderly individuals with PD to reduce unnecessary polypharmacy.

Prevalence and predictors of non-evidence based proton pump inhibitor use among elderly nursing home residents in the US.

Proton pump inhibitors (PPIs) can lead to several adverse effects among the elderly, particularly when used inappropriately or in contrast to evidence suggested protocols. The aim of this study was to examine the prevalence and predictors of non-evidence based PPI use in elderly nursing home residents. A cross-sectional study was conducted using data from the 2004 National Nursing Home Survey (NNHS). The study sample included nursing home residents 65 years and older. Descriptive statistics were used to examine the prevalence of non-evidence based PPI use. Multivariable logistic regression was used to evaluate the patient and facility-level factors associated with non-evidence based PPI use among the elderly nursing home residents. A total of 355,600 elderly nursing home residents received at least one PPI for an overall prevalence of 26.99%. Among those elderly receiving PPIs, 48.59% of the use was not evidence based. Multivariable logistic regression revealed that residents with osteoporosis (Odds Ratio (OR): 0.55, 95% CI: 0.45-0.68), SSRI users (OR: 0.81, 95% CI: 0.68-0.97) and those residing in micropolitan area (OR: 0.79, 95% CI: 0.63-0.98) were negatively associated with prescription of PPIs without an indication. Patients with chronic cough (OR: 2.10, 95% CI: 1.12-3.96) and Medicare insurance (OR: 1.23, 95% CI: 1.01-1.50) were positively associated with prescription of PPIs without an indication. The current study found that almost half of the elderly nursing home residents used PPIs for non-evidence based indications. Given the safety concerns and high non-evidence based use of PPIs in nursing homes, there is an urgent need to optimize PPI use in the elderly.

Cancer care cost trends in the United States: 1998 to 2012.

The authors examine trends in spending on cancer from 1998 through 2012, including cancer care costs, prevalence, and cases by payer, and discuss the results within the context of a prior analysis and recent health policy and programmatic changes. Condition-specific distribution of expenditures from the Medical Expenditure Panel Survey, supplemented with results from the National Nursing Home Survey and other data sources, was used as the basis for allocating the Personal Health Care components of the National Health Expenditure Accounts among conditions. Cancer care expenditures grew at an annualized rate of 2.9% from 1998 to 2012. The share of expenditures for hospital-based care declined to a low of 48% during 2007 through 2009. Professional and clinical services' shares declined substantially between 2007 to 2009 and 2010 to 2012 when the hospital share increased. Treated prevalence decreased for all payers between the first and last study periods with the exception of private payers (11.2% increase). Out-of-pocket expenditures declined to 4.7%, whereas Medicare's share increased slightly. Medication expenditures increased, notably within retail and mail order settings. The previous rapid growth of cancer prevalence and expenditures has now slowed, most remarkably since the 2007 recession. Out-of-pocket expenses for cancer treatment continue to decline, most recently reaching the lowest point in 25 years. In addition, the early effects of Affordable Care Act expansion can be observed in the decline of treated prevalence in the Medicaid population as the demographics of Medicaid enrollees change.

Facility Characteristics and Risk of Developing Pressure Ulcers in US Nursing Homes.

This research studied 12,507 residents in 1174 nursing homes from the 2004 National Nursing Home Survey. A multinomial logistic regression model was used to predict risk-adjusted probabilities of pressure ulcers with 4 stages. A medical director or a director of nursing on board reduced the odds of ulcers. Facilities offering clusters of beds for rehabilitation and special care programs for hospice care or behavior problems reduced the odds of stage IV ulcers.

Restorative Care's Effect on Activities of Daily Living Dependency in Long-stay Nursing Home Residents.

(a) Identify the prevalence of nursing homes providing Medicare supported restorative care programs and of long stay participants, (b) compare characteristics between restorative care participants and nonparticipants, and (c) assess restorative care's effect on change in activities of daily living (ADL) dependency. Longitudinal analysis of Minimum Data Set assessments linked to the 2004 National Nursing Home Survey using a sample of 7,735 residents, age ≥ 65 years living in 1,097 nursing homes for at least 6 months. Receipt of any restorative care was used as a time varying predictor to estimate change in ADL dependency over 18 months using linear mixed models. The sample was 75% female, 89% non-Hispanic White, with a mean age of 85±8, and average length of stay of 3.2±3.4 years. Most nursing homes had restorative care programs (67%), but less than one-third of long-stay residents participated. After controlling for resident and nursing home characteristics, the predicted mean ADL dependency score (range 0-28) at baseline was 18 for restorative care participants and 14 for nonparticipants. Over 18 months, ADL dependency increased 1 point for both participants and nonparticipants (p = .12). A minority of long-stay residents participated in Medicare supported restorative care programs despite their availability and potential benefits. Even though participants had greater vulnerability for deterioration in physical, mental, and functional health than nonparticipants, both groups had similar rates of ADL decline. Future research is needed to determine if providing restorative care to less dependent long-stay residents is effective.

Heart Failure Management in Skilled Nursing Facilities: A Scientific Statement From the American Heart Association and the Heart Failure Society of America

Heart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age. 1 Go A.S. Mozaffarian D. Roger V.L. Benjamin E.J. Berry J.D. Blaha M.J. Dai S. Ford E.S. Fox C.S. Franco S. Fullerton H.J. Gillespie C. Hailpern S.M. Heit J.A. Howard V.J. Huffman M.D. Judd S.E. Kissela B.M. Kittner S.J. Lackland D.T. Lichtman J.H. Lisabeth L.D. Mackey R.H. Magid D.J. Marcus G.M. Marelli A. Matchar D.B. McGuire D.K. Mohler 3rd, E.R. Moy C.S. Mussolino M.E. Neumar R.W. Nichol G. Pandey D.K. Paynter N.P. Reeves M.J. Sorlie P.D. Stein J. Towfighi A. Turan T.N. Virani S.S. Wong N.D. Woo D. Turner M.B. on behalf of the American Heart Association Statistics Committee and Stroke Statistics SubcommitteeHeart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014; 129: e28-e292 Crossref PubMed Scopus (512) Google Scholar Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2 Ahmed A.A. Hays C.I. Liu B. Aban I.B. Sims R.V. Aronow W.S. Ritchie C.S. Ahmed A. Predictors of in-hospital mortality among hospitalized nursing home residents: an analysis of the National Hospital Discharge Surveys 2005–2006. J Am Med Dir Assoc. 2010; 11: 52-58https://doi.org/10.1016/j.jamda.2009.08.003 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar , 3 Jones A.L. Dwyer L.L. Bercovitz A.R. Strahan G.W. The National Nursing Home Survey: 2004 overview. Vital Health Stat 13. 2009; : 1-155 PubMed Google Scholar Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities.

Payer Source for Single, Elderly Women in Nursing Homes

This study seeks to determine the payer source for single, elderly women in nursing homes by using secondary data from the 2004 National Nursing Home Survey was extracted and analyzed for the aforementioned hypotheses. By determining the payer source for single, elderly women, the next generation of women can prepare for high nursing home costs by saving earlier or investing in long-term care insurance. The analyses indicated self-pay and Medicaid was the primary sources for elderly women in nursing homes. Marital status did not have an impact on the payer source for elderly women. Single women did not have different payer sources than married elderly women. However, the study did not focus on payer sources for single, elderly women in nursing homes, but the demographic population as a whole.

Markers of Impaired Decision Making in Nursing Home Residents: Assessment by Nursing Home Staff in a Population-Based Study

IntroductionMany nursing home residents have cognitive impairment that affects their decision making. In order to identify potential markers of impaired decision making, we investigated the association between a range of nursing home resident characteristics and impaired decision making in a population-based sample. MethodsParticipants were 13,013 residents in the 2004 National Nursing Home Survey. We used logistic regression to determine the association between resident characteristics (ie, gender, age, race, mood, recent pain, falls, fractures, or hospitalizations, length of stay, number of activities of daily living (ADL) requiring help, and diagnoses of dementia, anxiety disorders, and depression) and impaired (vs independent) decision making. ResultsAfter controlling for depression and anxiety diagnoses, as well as gender, age, race, and recent hospitalization or pain, characteristics associated with impaired decision making included depressed, sad, or anxious mood [“mild” odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.23–1.58; “severe” OR = 2.69, 95% CI = 2.27–3.20); diagnosed dementia or living on a dementia hall (OR = 5.07, 95% CI = 4.52–5.67); number of ADL requiring assistance (with 5 ADL, OR = 10.69, 95% CI = 6.82–16.75); length of nursing home stay [101–365 days (OR = 1.60, 95% CI = 1.36–1.89); 366 days-2 years (OR = 1.60, 95% CI = 1.34–1.90); >2 years (OR = 2.25, 95% CI = 1.92–2.63)]; and history of falls or fractures in the last 6 months (OR = 1.19, 95% CI = 1.07–1.32)]. Residents reporting pain in the last week were less likely to have impaired decision making (OR = 0.58, 95% CI = 0.52–0.66). ConclusionsWe found several independent markers of impaired decision making in nursing home residents, including depressed, sad, or anxious mood (independent of depression or anxiety diagnosis); dementia; and greater need for ADL assistance. Some of these factors, in particular mood, are modifiable and addressing them may help improve decision making. These markers should be explored further to help identify residents with impaired decision making.

Total and State-Specific Medical and Absenteeism Costs of COPD Among Adults Aged 18 Years in the United States for 2010 and Projections Through 2020

COPD remains a leading cause of morbidity and mortality. The objectives of this study were to estimate (1) national US COPD-attributable annual medical costs by payer (direct) and absenteeism (indirect) in 2010 and projected medical costs through 2020 and (2) state-specific COPD-attributable medical and absenteeism costs in 2010. We used the 2006-2010 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, and 2010 Centers for Medicare and Medicaid Services data to generate cost estimates and 2010 census data to project medical costs through 2020. In 2010, total national medical costs attributable to COPD and its sequelae were estimated at $32.1 billion, and total absenteeism costs were $3.9 billion, for a total burden of COPD-attributable costs of $36 billion. An estimated 16.4 million days of work were lost because of COPD. Of the medical costs, 18% was paid for by private insurance, 51% by Medicare, and 25% by Medicaid. National medical costs are projected to increase from $32.1 billion in 2010 to $49.0 billion in 2020. Total state-specific costs in 2010 ranged from $49.1 million in Wyoming to $2.8 billion in California: medical costs ranged from $42.5 million in Alaska to $2.5 billion in Florida and absenteeism costs ranged from $8.4 million in Wyoming to $434.0 million in California. Costs attributable to COPD and its sequelae are substantial and are projected to increase through 2020. Evidence-based interventions that prevent tobacco use and reduce the clinical complications of COPD may result in potential decreased COPD-attributable costs.

Leadership education, certification and resident outcomes in US nursing homes: Cross-sectional secondary data analysis

BackgroundLeadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. ObjectivesTo examine associations of education and certification among NHAs and DONs with resident outcomes. DesignCross-sectional secondary data analysis. SettingsThis study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). Participants1142 nursing homes in the survey which represented 16628 nursing homes in the US. MethodsLeadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. ResultsNursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. ConclusionsSelected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships.

Nursing Home Leadership Tenure and Resident Care Outcomes

Because of the relatively short tenure of nursing home leaders in their facilities, questions have been raised about the relationship between the length of tenure and the quality of care. The objective of this data analysis was to determine whether the tenure of nursing home administrators (NHAs) and directors of nursing (DONs) in their current facility or any facility was associated with quality as measured by survey deficiencies. This cross-sectional secondary data analysis linked tenure data from the National Nursing Home Survey and quality (deficiency) data from the Online Survey , Certification , and Reporting system to explore this relationship. Following descriptive analysis of tenure, odds ratios and confidence intervals were calculated in the presence of covariates, using Generalized Estimating Equations with a logit link. Many NHAs and DONs had relatively short tenures (less than 1 year) at their current facility (NHA 23%; DON 42%), although most had experience at other facilities. When compared to peers with long tenure, short tenure of NHAs was associated with twice the odds of having a deficiency. Short tenure of DONs was associated with four times the odds the facility had severe deficiencies as long tenure. Additional covariates, including additional experience, did not influence the results. Increasing leadership tenure in nursing facilities should be a component of quality nursing home improvement.