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Examining the cost-benefit of additional staffing in Long Term Care (LTC) facilities
RS2002/03-DG27
Final Report Date: May 2005
| Principal Investigator: |
Annalee Yassi (University of British Columbia) |
| Co-Investigators | Marcy Cohen (Hospital Employees' Union); Ilhyeok Park (University of British Columbia) |
For more information about this development grant project, please contact Annalee Yassi.
Issue
A recent study found a possible relationship between staffing levels and injury rates in Intermediate Care facilities. This project was a follow-up study to further examine this possible relationship, using a larger sample of Intermediate Care facilities as well as extended care and multi-level care facilities. The potential for reducing injury rates in LTC facilities by increasing staffing levels was also explored.Key findings
- The staffing levels (number of residents per staff) in Intermediate Care facilities demonstrated a direct correlation with injury rates at low injury rate levels, but a less direct relationship at higher injury rate levels. This suggests that other factors beyond staffing levels are affecting the injury rates at higher injury rate levels.
- A statistically significant correlation between staffing levels and injury rates was found for “other staff”, but not for any of the other occupational groups examined (e.g., Registered Nurses, Care Aides, etc.).
Objectives
- To examine the staffing/injury rate relationship in 174 Long-Term care (LTC) facilities, by conducting secondary analysis of WorkSafeBC injury databases linked with Labour Relations Board staffing databases.
- To explore the staffing/injury rate relationship across care levels and occupational groups.
Method
Injury rates and staffing levels were calculated separately for the following occupational groups: Registered Nurses (RNs), Licen s ed Practical Nurses (LPNs), Care Aides (CAs), a combination of LPNs and CAs (LPNCAs), Direct Care (RNs and LPNCAs), support staff (housekeeping, food services/dietary, laundry) and “other staff”. “Other staff” included recreation aides, physiotherapists, occupational therapists, clerical workers, maintenance workers, social workers and chaplains.
Statistical analyses were conducted to examine variances in injury rates in relation to staffing levels within occupational groups and across care levels.
Results
Generally, lower resident-to-staff ratios were associated with facilities in the lowest injury rate category, and higher resident-to-staff ratios were associated with facilities in the highest injury-rate category. However, multiple regression analysis revealed that staffing-related variables explained only a small proportion of variance in injury rates.
While a linear trend was observed for the Intermediate Care facilities in the lowest injury rate quartile, this relationship did not apply to the highest injury rate quartile.
For RNs and LPNs only, the resident-to-staff ratio had an inverse relationship to injury rates, meaning that as the resident-to-staff ratio for these groups increased, the injury rate decreased.
Conclusions
The results demonstrate only a minimal/weak relationship between occupational injury rates and occupational staffing levels. The indirect nature of the staffing/injury rate relationship at higher injury rate levels suggests that a change in staff ratio does not lead to a direct change in injury rate, and that other factors are influencing the relationship to make it less direct.
The care responsibilities of workers may affect injury/staffing relationship. For RNs and LPNs, as the resident to staffing ratio increases, the worker's care responsibilities shift from lifting/transferring duties (physically demanding work) to medical care and medication responsibilities (less physically demanding work). As a result, these occupations experience lower levels of musculoskeletal injuries.
Future directions
Additional research is needed to investigate the relative impact of other organizational factors, such as organizational culture and communication, on injury rates in LTC facilities. Future research would also benefit from addressing two key limitations of the data in the current study: the large number of “unspecified claims” and the lack of data on “time of injury”.