Resource allocation and resident outcomes in nursing homes: comparisons between the best and worst

Abstract

The purpose of this study was to identify patterns of resource allocation that relate to resident outcomes in nursing homes. Data on structure, staffing levels, salaries, cost, case mix, and resident outcomes were obtained from state-level, administrative databases on 494 nursing homes. We identified two sets of comparison groups and showed that the group of homes with the greatest percentage of improvement in resident outcomes had higher levels of registered nurse (RN) staffing and higher costs. However, comparison groups based on best-worst average outcomes did not differ in resource allocation patterns. Additional analysis demonstrated that when controlling for RN staffing, resident outcomes in high- and low-cost homes did not differ. The results suggest that, although RN staffing is more expensive, it is key to improving resident outcomes.

Figure 1

Comparison of residual values for best and worst groups on average resident outcomes (top) and least and most improvement groups (bottom) after adjusting for casemix.

Figure 2

Comparison of residual values for improvement in outcomes between least and most groups on RN resource allocation (top) and lowest and highest groups on cost per resident day (bottom).