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Severe neighborhood deprivation and nursing home staffing in the United States.

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Title: Severe neighborhood deprivation and nursing home staffing in the United States.
Authors: Falvey, Jason R., Hade, Erinn M., Friedman, Steven, Deng, Rebecca, Jabbour, Joelle, Stone, Robyn I., Travers, Jasmine L.
Source: Journal of the American Geriatrics Society. Mar2023, Vol. 71 Issue 3, p711-719. 9p.
Subjects: Confidence intervals, Cross-sectional method, Regression analysis, Employee recruitment, Nursing care facilities, Comparative studies, Labor supply, Socioeconomic disparities in health, Nurses, Descriptive statistics, Research funding, Working hours, Health equity, Neighborhood characteristics, Medical needs assessment, Employee retention
Geographic Terms: United States
Abstract: Background: Low nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States. Methods: This cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates. Results: Compared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2–6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs. Conclusions: Significant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Severe neighborhood deprivation and nursing home staffing in the United States.
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  Data: <searchLink fieldCode="AR" term="%22Falvey%2C+Jason+R%2E%22">Falvey, Jason R.</searchLink><br /><searchLink fieldCode="AR" term="%22Hade%2C+Erinn+M%2E%22">Hade, Erinn M.</searchLink><br /><searchLink fieldCode="AR" term="%22Friedman%2C+Steven%22">Friedman, Steven</searchLink><br /><searchLink fieldCode="AR" term="%22Deng%2C+Rebecca%22">Deng, Rebecca</searchLink><br /><searchLink fieldCode="AR" term="%22Jabbour%2C+Joelle%22">Jabbour, Joelle</searchLink><br /><searchLink fieldCode="AR" term="%22Stone%2C+Robyn+I%2E%22">Stone, Robyn I.</searchLink><br /><searchLink fieldCode="AR" term="%22Travers%2C+Jasmine+L%2E%22">Travers, Jasmine L.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Journal+of+the+American+Geriatrics+Society%22">Journal of the American Geriatrics Society</searchLink>. Mar2023, Vol. 71 Issue 3, p711-719. 9p.
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  Data: Background: Low nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States. Methods: This cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates. Results: Compared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2–6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs. Conclusions: Significant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/jgs.17990
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        Text: English
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        PageCount: 9
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      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Cross-sectional method
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      – SubjectFull: Regression analysis
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      – SubjectFull: Employee recruitment
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              Text: Mar2023
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