Introduction of hospice services by nursing homes does not significantly affect nursing assistant staffing
Research Activities, August 2012, No. 384
More and more nursing homes are providing hospice care to their residents. End-of-life care is managed by hospice organizations, which can also provide routine hands-on care normally provided by certified nursing assistants (CNAs). As a result, nursing homes could reduce staffing, thereby serving as an incentive for hospice referrals. However, a new study finds that the introduction of hospice services in nursing homes does not result in significant CNA staffing changes. Rather, as hospice patient volume increased, small increases in CNA staffing were observed.
Researchers included in their study free-standing nursing homes that ranged from 30 to 500 beds. Data were collected from two Medicare databases that contain information on nursing home care, including the transition of residents from one facility to another and from one care type to another.
Overall, 45 percent of the nursing homes studied had at least 1 percent of resident days covered by hospice services in 1999. This began to rise significantly after 2000. By 2006, nearly 80 percent of all nursing homes offered hospice. Introducing hospice services did not significantly affect the number of minutes per day spent by CNAs at patient bedsides. However, as hospice volume increased, so did time spent with patients. For every 1,000 hospice days added every year, time spent with patients grew by more than three-quarters of a minute. This means that nursing homes did not shrink nurse assistant staffing by receiving additional hospice staff. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00011).
See "Effect of increased nursing home hospice use on nursing assistant staffing," by Denise A. Tyler, Ph.D., Natalie Leland, Ph.D., O.T.R./L., Michael Lepore, Ph.D., and Susan C. Miller, Ph.D., in the Journal of Palliative Medicine 14(11), pp. 1236-1239, 2011.