The Contribution of the Nursing Home Caring Profile to the Probability of Hospitalizing Adult Nursing Home Residents

Background: Nursing homes provide 24-hour custodial support, supervision, and health care to individuals who are unable to live in an alternate setting. Adult long-stay residents are prone to subtle changes within their environment and are often unable to compensate for these fluctuations prompting the need for additional care. This further care is typically provided in a hospital. These hospitalizations are detrimental to the resident's health and wellbeing, are expensive, and consume a significant amount of resources. For example, hospitalizations increase the risk of the resident developing nosocomial infections, having adverse and iatrogenic events, and alter the patterns of care that may lead to further loss of the resident's functional and cognitive abilities. Current financial incentives encourage hospitalizations in this population, even if the necessary care could be provided within the nursing home. This occurs because the resident's additional care requirements may increase resource utilization and cost which the nursing home may wish to avoid. Research demonstrates that a significant proportion of these hospitalizations are avoidable and unnecessary. Several multifactorial interconnected relationships have been noted to influence a hospitalization in this population. However, a complete understanding of these occurrences is lacking due to the absence of standardized definitions of key variables coupled with difficulties in measuring these complex constructs. These challenges presented a compelling reason to further study this phenomenon.;Purpose: The goal of this study was to examine the level of investment that the nursing home commits to the adult long-stay resident in the provision of labor and technology to the probability of a hospitalization while controlling for resident and facility characteristics.;Design and Methodology: This study examined data from the 2004 National Nursing Home Survey, a nationally representative cross-sectional sample of nursing homes, residents, discharges, and staff. An index was constructed as a means to quantify and examine the varying degrees of commitment that the nursing home makes to the resident by investing in labor and technology. This index included variables that may potentially substitute for hospital care and may incentivize direct care nursing staff to work in the nursing home. The Investment-in-Care Index included two major categories: labor and technology. Within the labor index were three sub-indices: wages, provider qualifications, and provider motivations. The wage index examined each category of direct care nurses' wages and full time equivalents. The provider motivation index measured the number of direct and indirect benefits offered to the nursing staff. The provider qualifications index quantified the type of additional education and training that the nursing home provided to its nursing staff to care for the resident. The technology index included a summative index with four sub-indices: electronic information systems, lifting devices, and the provision of special care units and special care programs. The electronic information systems index measured the number of health information technology variables that were directly related to resident care. The lifting device index measured the presence or absence of this potentially labor saving equipment. The special care unit index calculated the presence or absence of designated areas within the nursing home for the provision of care to residents with specific diseases. The calculation of the special care program index enumerated the presence or absence of potentially hospital substituting therapies: infusion therapy, peritoneal dialysis, and hemodialysis. After the aggregate index was constructed, descriptive statistics were performed and bivariate analyses were conducted. Thereafter, a logistic regression analysis was completed to explore the key predictors.;Results: Examination of the constructed Investment-in-Care Index within the model revealed one significant predictor, registered nurse, RN, wage index. This finding may be explained by the presence of additional RNs in the nursing home who have the knowledge and clinical expertise to detect subtle clinical changes in the resident prompting the need for additional care. The reason for non-significance in the investment in technology index may be related to the overall cost in providing these services and the lack of reimbursement from payers. In addition, these indexes may have served as modifying factors, which were not examined in this study. While the model did not support the majority of predictors, this study did yield vital information regarding the multidimensionality of key components and the variability in the delivery of care. Several resident level variables predicted the likelihood of a hospitalization: being male, requiring assistance with a greater number of activities of daily living, taking more medications, and living in the Midwest, South, or West. These findings were consistent with other studies and highlighted existing socioeconomic disparities. (Abstract shortened by UMI.).