Variations in staffing and resident care patterns in Michigan nursing homes
Objective: To examine variations in resident care practices and staffing in Michigan nursing facilities. Design/Setting: Nonconcurrent prospective cohort study. Participants: Michigan nursing facilities (41,344 residents), compiled by the Michigan Department of Consumer and Industry Services (MDCIS) between May 1994 and May 1995. Measurements: The primary measurements were taken from (1) Health Care Financing Administration form HCFA-672 (ownership type, resident census, payment source, and resident conditions and care practices); (2) MDCIS quarterly reports (occupancy rate, staffing level, and number of direct-care hours delivered to each resident per day); and (3) 1990 U.S. Census and Michigan Department of Public Health Health Service Areas (facility location). Results: Seventy-six percent of the nursing homes were for-profit facilities (FP), 15% were not-for-profit (NFP), and 9% were county-owned (CO). Medicaid was the payment source for 67% of residents in the FP nursing homes, 53% of those in the NFP homes, and 74% of those in the CO homes (P < .001). Comparisons of resident conditions and care practices showed significant differences in the mean percentages of residents with indwelling urinary catheters (6.0% FP, 5.1% NF, and 10.4% CO; P< .001) and advance care directives (58.0% FP, 70.6% NFP, and 63.6% CO; P = .009). County-owned facilities were more likely to have higher levels of direct-care hours per day for their residents (3.5 hours per day versus 3.0 FP and 3.2 NFP; P< .001). Nursing homes that are located in large metropolitan areas had a higher mean prevalence of pressure ulcers and feeding tubes in their residents and a lower mean prevalence of advance care directives and direct- care hours per resident per day. Conclusions: Despite recent regulatory changes for nursing facilities, major variations in resident care patterns exist by both ownership type and geographic region in Michigan nursing facilities.
