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Caregivers Are Quality in Long Term Care

Slide Presentation by Christine T. Kovner, R.N., Ph.D.

On April 30, 2003, Christine T. Kovner, R.N., Ph.D., made a presentation in the Web-Assisted Audioconference entitled Caregivers and Quality in Long Term Care.

This is the text version of Dr. Kovner's slide presentation. Select to access the PowerPoint® slides (194 KB).

Caregivers Are Quality in Long Term Care

Christine T. Kovner, R.N., Ph.D.
Division of Nursing
Steinhardt School of Education

Slide 1

Caregivers Are Quality in Long Term Care

Christine T. Kovner, R.N., Ph.D.
Division of Nursing, Steinhardt School of Education, NYU
April 30, 2003

Slide contains a picture of Christine Kovner.

Slide 2

Total Nurse Staffing Hours per Resident per Day, 2001

  • Certified nurse aides (CNA)—2.1 hours.
  • Licensed practical/vocational nurse (LPN/LVN)—0.7 hours.
  • Registered nurses (RN)—0.7 hours.
  • Only RN hours have increased from 0.4 hours per day in 1993, while acuity has increased.

Source: Harrington from CMS OSCAR data.

Slide 3

Reported Staff Ratios on each Shift—Nursing Homes 2001

  • 1 CNA to 11.8 Residents.
  • 1 LVN/LPN to 34 Residents.
  • 1 RN to 32 Residents.

Source: Harrington from CMS OSCAR data.

Slide 4

Research Studies: Positive Relationship Between Licensed Nurses & Quality

  • Increased licensed nursing hours were related to improved functional ability and decreased probability of death.
  • Facilities with higher nurse staffing levels have fewer deficiencies.
  • Facilities with more RNs per LPN had fewer assessment deficiencies.

Source: Bliesmer, et al., 1998; Harrington, et al., 2000; Moseley & Jones, 2003.

Slide 5

Research Studies: Positive Relationship Between Licensed Nurses & Quality

  • Nursing homes meeting HHS preferred minimum staffing levels had no violation that caused actual harm to patients.
  • 68 percent of homes that did not meet HHS standards had such violations.
  • Less than 2.0 hours of nurse aid care per nursing home resident were almost 4 times more likely to get pressure sores than those in nursing homes that provided more than 2 hours.

Source: (Stark report, 2001); (DHHS Report to Congress: Appropriateness of Minimum Nursing Staffing Ratios in Nursing Homes, 12- 1 (Spring 2000).

Slide 6

Medication Errors in Home Care for Patients 65 years and older

  • 1.4 percent of patients taking medications older adults should always avoid.
  • 8.4 percent of patients taking medications rarely appropriate for older adults.

Source: Kovner, Menezes, & Feldman, 2003; MEPS data from AHRQ.

Slide 7

Occupational Training Requirements

Many believe minimum training for nursing assistants should be increased:

  • Nursing Assistants—75 hours.
  • Manicurists—400 hours.
  • Barber—1500 hours.


Slide 8

Recommended Nursing Hours in NHs (direct and indirect)

Slide contains a chart showing the recommended hours in NHs for registered nurses: 69 minutes (1.15 hours) per day; for licensed practical/vocational nurses: 42 minutes (.70 hours) per day; for nursing assistants: 162 minutes (2.7 hours) per day; for total nursing: 273 minutes (4.55 hours) per day.

Slide 9

Geriatric Preparation

  • Less than <1 percent (21,500) of working RNs are certified in geriatrics.
  • Fewer than 0.3 percent (333) of the 97,362 physician residents slots are for geriatrics.
  • Only 0.3 percent (720) of 200,000 pharmacists have geriatric certification.

Source: Kovner, C.T., Mezey, M., & Harrington, C. (2002).

Slide 10


Anderson, R A, Hsieh, P, Su, H (1998). Resource allocation and resident outcomes in nursing homes: Comparisons between the best and worst. Research in Nursing and Health 21:297-313.

Kovner, CT, Menezes, J, Feldman, P (2003). Paper in progress.

Harrington, C, Kovner, C, Mezey, M, et al (2000). Experts recommend minimum nurse staffing standards for nursing facilities in the U.S. The Gerontologist 40:5-16.

Kovner, CT, Mezey, M, Harrington, C (2002). Who cares for older adults? Workforce implications of an aging Society. Health Affairs 21(5):78-89.

Bliesmer, M M, Smayling, M, Kane, R, et al (1998) The relationship between nursing staffing levels and nursing home outcomes. Journal of Aging and Health 10(3):351-71.

Harrington, C, Zimmerman, D, Karon, SL, et al (2000). Nursing home staffing and its relationship to deficiencies. Journal of Gerontology: Social Sciences 55B(5):S278-87.

Linn, MGL, Linn, BA (1977). Patient outcomes as a measure of quality of nursing home care. American Journal of Public Health 67(4):337-44.

Nyman, JA (1988). Improving the quality of nursing home outcomes: Are adequacy or incentive-oriented policies more effective? Medical Care, 26(12):1158-71.

Kayser-Jones, Wiener, CL, Barbaccia, JC (1989). Factors contributing to the hospitalization of nursing home residents. The Gerontologist 29:502-10.

Spector, WD, Takada, HA (1991). Characteristics of nursing homes that affect resident outcomes. Journal of Aging and Health 3(4):427-54.

Cherry, RL (1991). Agents of nursing home quality of care: Ombudsman and staff ratios revised. The Gerontologist 31:302-8.

Kayser-Jones, J, Schell, E (1997). The effect of staffing on the quality of care at mealtime. Nursing Outlook 45(2):64-72.

Harrington, C, Carrillo, H, Thollaug, S, et al (1999). Nursing facilities, staffing, residents, and facility deficiencies 1991-1997. (Report prepared for the Health Care Financing Administration. San Francisco: University of California.

Current as of July 2003

Internet Citation

Caregivers Are Quality in Long Term Care. Text Version of a Slide Presentation at a Web-assisted Audioconference. Agency for Healthcare Research and Quality, Rockville, MD.

Return to Audioconference

The information on this page is archived and provided for reference purposes only.

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