Biomedical subjects

Nicholas G Castle

Publications and source records attributed to Nicholas G Castle.

At least 19 recordsLinked to original sources

PubMed2006

Determinants of staff job satisfaction of caregivers in two nursing homes in Pennsylvania.

BACKGROUND: Job satisfaction is important for nursing home staff and nursing home management, as it is associated with absenteeism, turnover, and quality of care. However, we know little about factors associated with job satisfaction and dissatisfaction for nursing home workers. METHODS: In this investigation, we use data from 251 caregivers (i.e., Registered Nurses, Licensed Practical Nurses, and Nurse Aides) to examine: job satisfaction scores of these caregivers and what characteristics of these caregivers are associated with job satisfaction. The data were collected from two nursing homes over a two and a half year period with five waves of data collection at six-month intervals. The Job Description Index was used to collect job satisfaction data. RESULTS: We find that, overall nursing home caregivers are satisfied with the work and coworkers, but are less satisfied with promotional opportunities, superiors, and compensation. From exploratory factor analysis three domains represented the data, pay, management, and work. Nurse aides appear particularly sensitive to the work domain. Of significance, we also find that caregivers who perceived the quality of care to be high have higher job satisfaction on all three domains than those who do not. CONCLUSION: These results may be important in guiding caregiver retention initiatives in nursing homes. The finding for quality may be especially important, and indicates that nursing homes that improve their quality may have a positive impact on job satisfaction of staff, and thereby reduce their turnover rates.

Adult↗

PubMed2006

Mental health care deficiency citations in nursing homes and caregiver staffing.

In this paper, we examine the association between caregiver staffing levels and mental health outcomes in approximately 17,000 U.S. nursing homes. As outcomes, we focus on deficiency citations available in the Center for Medicare and Medicaid Services' Online Survey, Certification, And Recording data. We examine nurse aide, licensed practical nurse, registered nurse, and mental health provider staffing. Our results show that the level of nursing staff matter with respect to mental health outcomes. Whereas greater RN staffing was associated with a lower likelihood of being cited for deficiencies in mental health care, greater LPN and NA staffing were associated with a higher likelihood. We found no association between mental health provider staffing levels and mental health outcomes.

Health Care Surveys↗

PubMed2006

Mental health outcomes and physical restraint use in nursing homes {private}.

We investigate the nexus between mental health outcomes in nursing home residents and the use of physical restraints. Previous studies in this area used limited statistical tests such as correlations and t-tests, that could not account for potential biases, such as residents who become mentally disturbed may be most likely to be restrained. We use propensity matching models that are less susceptible to this bias and data from the Minimum Data Set, representing approximately 2,000 residents over a period of 6 years. Our results clearly show that restrained residents are more likely to become more impaired with respect to cognitive performance, depression, and social engagement. We conclude that if facilities reduce restraint use then the prevalence of resident mental health problems will also likely decline.

Aged↗

PubMed2006

Organizational characteristics associated with staff turnover in nursing homes.

PURPOSE: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. DESIGN AND METHODS: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey). RESULTS: The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of nursing staff. IMPLICATIONS: Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between nursing homes, based on their organizational characteristics.

Aged↗

PubMed2006

Measuring staff turnover in nursing homes.

PURPOSE: In this study the levels of staff turnover reported in the nursing home literature (1990-2003) are reviewed, as well as the definitions of turnover used in these prior studies. With the use of primary data collected from 354 facilities, the study addresses the various degrees of bias that result, depending on how staff turnover is defined in nursing homes. DESIGN AND METHODS: Data came from a survey mailed to administrators of 526 nursing homes during March 2003. Facilities were located in four states: Missouri, Texas, Connecticut, and New Jersey. Three hundred and fifty-four responses were received, giving a response rate of 67%. RESULTS: The 1-year turnover rates identified in these facilities were 119%, 89%, 87%, 57%, and 48%, for nurse aides, licensed practical nurses, registered nurses, administrators, and directors of nursing, respectively. However, findings show that the definition of turnover used could influence the relative difference between these reported rates by as much as 47%. IMPLICATIONS: As a result of measurement error, turnover rates may be misrepresented in prior studies. On the basis of the results of this investigation, several recommendations are made for future data-collection initiatives that will eliminate some of this measurement error.

Data Collection↗

PubMed2006

Administrative deficiency citations and quality of care in nursing homes.

In this investigation, we examine deficiency citations for administration in nursing homes. Administration is defined as the top managers in each facility, consisting of the nursing home administrator and director of nursing. We examine the association between deficiency citations for administration (indicating poor administration practices) and quality of care. Regulators, as well as consumers, are interested in this association. Data used came from the 1996-2004 Online Survey, Certification And Recording (OSCAR) data, representing approximately 17,000 facilities per year. We find that 5% of facilities received a deficiency citation for administration, and lower facility quality is associated with these administration deficiency citations.

Certification↗

PubMed2005

State variability in indicators of quality of care in nursing facilities.

BACKGROUND: The objective of this research was to profile and compare state-level physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychoactive medication use as indicators of quality of care in nursing facilities. METHODS: Using nationally representative data from the Online Survey, Certification, and Reporting system for 2000 (N = 17,072), we calculated predicted quality scores using risk-adjusted models based on aggregate resident variables generated by hierarchical linear regression models for each of the five quality indicators. RESULTS: We observed significant variation in both the actual and risk-adjusted quality measures. The average risk-adjusted physical restraint quality score ranged from 8.4% to 12.8%; the average risk-adjusted catheterization quality score ranged from 3.6% to 7.7%; the average risk-adjusted contractures quality score ranged from 19.0% to 31.6%; the average risk-adjusted pressure ulcer quality score ranged from 3.8% to 7.6%; and the average risk-adjusted psychoactive medication quality score ranged from 47.8% to 56.9%. Eleven states had quality measures better than the risk-adjusted expectation for at least four of the five measures, and eight states were worse than expected in at least four of the five. CONCLUSIONS: This study provides evidence that there is variation in quality indicators across states. These differences exist even after risk adjustment. Our results may be important for state regulators trying to understand and improve quality.

Aged↗

PubMed2005

Report cards and nursing homes.

PURPOSE: We first describe which states have produced nursing home report cards; second, we compare what information is provided in these report cards; third, we identify data sources used to produce the report cards; and, finally, we examine seven factors previously shown to be associated with the usefulness of report-card information and provide several examples from current reporting efforts to illustrate how nursing home report cards could be improved. DESIGN AND METHODS: We searched the Web sites for each state agency responsible for elder affairs-nursing homes. For those states identified as having a nursing home report card, we further examined the information presented. RESULTS: We identified 19 states as having nursing home report cards (AZ, CO, FL, IL, IN, IO, MD, MA, MS, NV, NJ, NY, OH, PA, RI, TX, UT, VT, and WI). The information presented in these report cards differs quite substantially across states, although the data sources for report cards do not differ substantially. How the information is presented and our evaluation of the usefulness of the information is also highly varied. IMPLICATIONS: Providing nursing home report-card information may be important in helping elders and their families choose a nursing facility. With 19 states identified in our research as providing nursing home report-card information on the World Wide Web, we were surprised and encouraged at this number of initiatives. We give some insight into the kinds of information that can be found on these report cards and what steps could be taken to improve how the information is presented.

Consumer Behavior↗

PubMed2005

Turnover begets turnover.

PURPOSE: This study examined the association between turnover of caregivers and turnover of nursing home top management. The top managers examined were administrators and directors of nursing, and the caregivers examined were registered nurses, licensed practical nurses, and nurse aides. DESIGN AND METHODS: The data came from a survey of 419 nursing facilities and the Online Survey, Certification, and Reporting system. Multinomial logistic regression analyses were used to examine the association between turnover of nursing home top management and turnover of caregivers. RESULTS: A 10% increase in top management turnover is associated (p <.05) with a 21% increase in the odds that a facility will have a high turnover rate of nurse aides and is associated (p <.05) with an 8% decrease in the odds that a facility will have a low turnover rate of nurse aides. A 10% increase in top management turnover is associated (p <.1) with a 30% increase in the odds that a facility will have a high turnover rate for registered and licensed practical nurses. IMPLICATIONS: This study provides preliminary evidence that the turnover of top managers may have an important influence on caregiver turnover in nursing homes.

Caregivers↗

PubMed2005

Nursing home administrators' opinions of the nursing home compare web site.

PURPOSE: In November of 2002 the Centers for Medicare and Medicaid Services publicly reported on a national basis the quality of nursing homes on the Nursing Home Compare (NHC) Web site. This study examines administrators' opinions of this initiative and whether it has fostered quality improvement. DESIGN AND METHODS: Data used in this investigation come from a questionnaire mailed to the administrators of 477 nursing homes. Three hundred and twenty-four responses were received, giving a response rate of 68%. Facilities were located in four states: Connecticut, Maryland, Pennsylvania, and Tennessee. RESULTS: Ninety percent of the administrators examined the NHC Web site, 51% stated that they would be using the information for quality improvement in the future, and 33% stated that they were using NHC information in quality-improvement initiatives. IMPLICATIONS: For NHC to influence quality as it is intended, nursing home quality-of-care initiatives are essential. Study results show that administrators are generally accepting of the NHC Web site, and some are using the information in quality initiatives.

Health Facility Administrators↗

PubMed2005

Staff turnover and quality of care in nursing homes.

PURPOSE: In this work, the association between nurse aide (NA) plus licensed practical nurse (LPN) and registered nurse (RN) turnover and quality indicators in nursing homes is examined. DESIGN AND METHODS: Indicators of care quality used are the rates of physical restraint use, catheter use, contractures, pressure ulcers, psychoactive drug use, and certification survey quality of care deficiencies. In addition, we used a quality index combining these indicators. Turnover information came from primary data collected from 354 facilities in 4 states and other information came from the 2003 Online Survey, Certification and Reporting data. The turnover rates were grouped into 3 categories, low, medium, and high, defined as 0% to 20%, 21% to 50%, and greater than 50% turnover, respectively. RESULTS: The average 1-year turnover rates identified in this study were high at 85.8% for NAs and LPNs and 55.4% for RNs. Multivariate analysis shows that decreases in quality are associated with increases in RN turnover, especially increases from low-to-moderate levels of turnover, and with increases in NA and LPN turnover, especially increases from moderate-to-high levels of turnover. IMPLICATIONS: These findings are significant because the belief that staff turnover influences quality is pervasive. The cross-sectional results are only able to show associations, nonetheless, few empirical studies in the literature have shown this relationship.

Connecticut↗

PubMed2005

Review of the literature on survey instruments used to collect data on hospital patients' perceptions of care.

OBJECTIVE: To review the existing literature (1980-2003) on survey instruments used to collect data on patients' perceptions of hospital care. STUDY DESIGN: Eight literature databases were searched (PubMED, MEDLINE Pro, MEDSCAPE, MEDLINEplus, MDX Health, CINAHL, ERIC, and JSTOR). We undertook 51 searches with each of the eight databases, for a total of 408 searches. The abstracts for each of the identified publications were examined to determine their applicability for review. METHODS OF ANALYSIS: For each instrument used to collect information on patient perceptions of hospital care we provide descriptive information, instrument content, implementation characteristics, and psychometric performance characteristics. PRINCIPAL FINDINGS: The number of institutional settings and patients used in evaluating patient perceptions of hospital care varied greatly. The majority of survey instruments were administered by mail. Response rates varied widely from very low to relatively high. Most studies provided limited information on the psychometric properties of the instruments. CONCLUSIONS: Our review reveals a diversity of survey instruments used in assessing patient perceptions of hospital care. We conclude that it would be beneficial to use a standardized survey instrument, along with standardization of the sampling, administration protocol, and mode of administration.

Health Care Surveys↗

PubMed2005

Nursing home closures and quality of care.

The purpose of this research is to examine the relationship between quality of care in nursing homes and their likelihood of closure. We hypothesize that lower-quality facilities will be more likely to close than higher-quality facilities. Using the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychotropic medication use as quality measures from approximately 12,000 facilities from 1992 to 1998, the author examine cross-sectional and change score relationships between these measures and a nursing home's likelihood of closure. The descriptive analysis shows that 621 nursing homes closed in this time period, and the results for physical restraint use were robust in their positive association with closures in most analyses lending some support for this study's hypothesis. However, overall, the author concludes that nursing facility closures are relatively rare events. And the likelihood of closure, even for poor-quality facilities, is low.

Health Facility Closure↗

PubMed2005

Does quality pay for nursing homes?

Using physical restraints, urethral catheterization, pressure ulcers, psychotropic medication use, and contractures as quality indicators, this research examines whether the quality of nursing homes is associated with private-pay census. The primary data source was the 2000, 2001, and 2002 Online Survey Certification And Recording (OSCAR) data, which is nationally representative data containing information for approximately 17,000 nursing homes. The results of this study suggest that physical restraint use and psychotropic medication use have both a correlative and predictive relationship with private-pay census. Catheterization, pressure ulcers, and contractures are less important. The results of this study are important in two ways. First, the cross-sectional results show that the higher quality nursing homes are likely to have a higher private-pay census. Second, the change score analyses show that nursing homes can increase their private-pay census by increasing quality.

Cross-Sectional Studies↗

PubMed2005

Nursing home closures, changes in ownership, and competition.

This research examines the relationship of competition among nursing homes and the likelihood of their closure or change in ownership. The study uses nationally representative data from the 1992-1998 Online Survey, Certification, and Reporting system, and is supplemented with several other primary and secondary data sources. It is hypothesized that facilities located in more competitive environments will be more likely to close. Multinomial logistic regression analyses are employed to examine this hypothesis in a model containing organizational and aggregate resident characteristics, and market factors. The Herfindahl index is used as a measure of competition. The descriptive analysis shows that 621 nursing homes closed and 6,471 changed ownership from 1992 to 1998. The incidence rate of closures was .7% of facilities per year. The multivariate analysis shows that facilities located in more competitive environments were significantly more likely to close.

Aged↗

PubMed2004

Response formats and satisfaction surveys for elders.

PURPOSE: A factor common to the results of many satisfaction surveys of elders is a lack of response variability. Increasing response variability may be useful if satisfaction surveys of elders are to be productively used in the future. In this paper, we first examine elders' preferences between five response formats and then examine the response variability of these five commonly used formats. DESIGN AND METHODS: Satisfaction, demographic, and Short-Form 36 Health Survey data were self-reported by patients in four outpatient surgery centers during 1998 and 1999. We used six different survey instruments randomly given to 3,122 elders. Five instruments varied in response format (5-item Likert format, 5-item satisfaction format, 5-item valuation format, 4-item Chernoff faces, and 10-item visual analogue format). The sixth survey used all five different response sets, and then it asked for the respondents' preferences among the different response sets. RESULTS: A total of 2,450 questionnaires were examined (response rate of 78.5%). The response format using four Chernoff faces was liked the least, with only 5% of the respondents preferring this format. The 10-item visual analogue format (10VAF) was liked the most, with 39% of the respondents preferring this format. In addition, 10% more elders thought this format was easier to use than the second-place choice (i.e., 32% vs. 22%). The coefficient of variation for the 10VAF was also higher than those in identical domains using the other response formats. This would seem to indicate that the 10VAF is less prone to a ceiling effect than the other response formats. IMPLICATIONS: Our results show that elders have a preference for some response formats, and from the choices we gave them a 10VAF was preferred. The 10VAF also had more response variability then the other formats we tested.

Aged↗

PubMed2004

Nursing homes with persistent high and low quality.

This article examines the concentration of low- and high-quality care within particular nursing facilities over time. The authors explore three different explanations for persistent low and high quality over time including the level of public reimbursement, the presence of bed constraint policies such as certificate-of-need and construction moratoria, and the role of consumer information. Using 1991 through 1999 data from the On-Line Survey, Certification, and Reporting system, the authors show that both low- and high-quality nursing home care is concentrated in certain facilities over time. Their results further show that public reimbursement and asymmetric information are both important factors in explaining why low quality persists over time in certain facilities.

Certificate of Need↗

PubMed2004

Facility charter and quality of care for board and care residents.

In this investigation structure, process, and outcome measures of quality in for-profit and not-for-profit board and care homes are compared. We find one structural measure (providing nursing care), three process measures (food quality, staff treat residents with respect, and staff verbally abuse residents), and two outcomes measures (cleanliness of the facility and complaints to Ombudsman) to be significant. Moreover, the directions of these effects are all consistent, with for-profit facilities rated more poorly that not-for-profit facilities. These results are discussed emphasizing their implications for efficient and effective resident care.

Accidental Falls↗