Basic Organizational Changes Lead to Greater Quality of Care in Nursing Homes, Study Finds

Although understaffing is a common denominator of most injuries sustained by residents of California nursing homes, the issue of staffing is equally one of quality as it is quantity. Labor costs naturally comprise the most significant portion of a nursing home’s expenses. But both sufficient and qualified staffing are the essential components of a safe nursing home environment that not only prevents injuries to its residents, but actually improves their quality of life.

Often times, nursing home owners and operators make the unfortunate decision to place profits over people by cutting staffing and not providing sufficient qualified staff in order to increase their bottom line. Although much has and can be written about that issue, a recent study suggests other significant interventions that can improve the quality of care without significantly increasing staffing or costs of care.

Recently, the Journal of the American Medical Directors Association conducted a comprehensive, multi-level intervention in twenty nine Missouri nursing homes in need of improving quality of care and resident outcomes. The results of the two year study, published in August 2011, revealed that skilled nursing facilities can improve the quality of care they provide and enhance the health and safety of their residents without increasing staffing or costs of care. The study, entitled “Randomized Multilevel Intervention to Improve Outcomes of Nursing Homes in Need of Improvement”, is available for purchase online.

The 29 intervention facilities underwent a 2-year multilevel intervention with monthly on-site intervention from expert nurses with graduate education in gerontological nursing. Although shorter intervals are appropriate, a two year period was chosen to ensure that both the administrative and nursing staff could adopt and maintain the improved care-delivery practices implemented by the study. The theoretical model for the multilevel intervention was “getting the basics of care done”, with organizational changes such as consistent nursing leadership, consistent administrative leadership, and an active quality improvement program. The intervention targeted three levels of staff responsible for operating a nursing home: owners, administrative staff, and direct care staff.

The study found that resident outcomes improved through the interventions, particularly in the areas of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in ADL. One of the study’s findings was that staff retention improved in the intervention facilities (as opposed to the control facilities) as the leadership learned to involve staff in decision making and improvement programs. This was significant, given the consensus that direct care staff and administrator turnover is associated with a negative effect on quality of care. The results were encouraging, as the intervention did improve the quality of care in the areas of pressure ulcers and weight loss.

From a legal standpoint, implementing the findings of this study would serve the nursing home owners’ and operators’ best interests as well, as nursing homes are required to take all steps necessary to improve the quality of care by setting up an administrative system designed to improve quality of care. Specifically, Title 42 of the Code of Federal Regulations, Subpart B, section 483.75, entitled “Administration” mandates: “A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”

Essentially, the study finds that developing a greater and consistent management team dedicated to involving direct care givers in decision making and improvement programs can lead to greater quality of care. This is consistent with the findings linking high staff turnover with low quality of care levels. Most nurses are by nature dedicated to providing the best care they can to their patients, but they must be equipped with the tools and resources necessary to do so.


If you are faced with the decision to place a loved one in a nursing home, take the time to first visit the facility at different hours of the day and speak with the staff. Get a sense of the workload they are responsible for and how happy they are in their positions. For more information on important criteria to consider in selecting the appropriate nursing home for your loved one, visit California Advocates for Nursing Home Reform.

If your loved one has been the victim of neglect or abuse in a Long Beach nursing home in California, contact us for assistance.