The Influence of Consistent Assignment on Nursing Home Deficiency Citations

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Objective: The association of consistent assignment of nurse aides (NAs) with quality of care and quality of life of nursing home residents is examined (using 5 groups of deficiency citations). Methods: Data used came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The information including consistent assignment and staffing variables of registered nurses, licensed practical nurses, and NAs were measured in 2007 and came from 3,941 facilities. Negative binomial regression and multivariate logistic regression models were used. Results: An average of 68% of nursing homes in this sample reported using consistent assignment. However, the actual level of NA consistent assignment used varied substantially. Only 28% of nursing homes using NA consistent assignment did so at the often recommended level of 85% (or more). In the multivariate analyses, consistent assignment was associated with the deficiency citations examined in 4 of the 5 models. That is, quality of life deficiency citations (resident), quality of life deficiency citations (staffing), quality of life deficiency citations (facility), and quality of care deficiency citations were significantly (p < .01) lower in facilities with the highest levels of consistent NA assignment. Few significant findings were found in nursing homes using lower levels of consistent assignment. Conclusion: Consistent assignment has developed as a preferred practice in nursing homes based on little empirical evidence in the peer-reviewed literature. The findings presented here provide some justification for the use of this staffing practice for NAs.

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