Trends in long-term care staffing by facility ownership in British Columbia, 1996 to 2006

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by Margaret J. McGregor, Robert B. Tate, Lisa A. Ronald, Kimberlyn M. McGrail, Michelle B. Cox,
Whitney Berta and Anne-Marie Broemeling

Abstract
Keywords
Findings
Authors
What is already known on this subject?
What does this study add?

Abstract

Background

Long-term care facilities (nursing homes) in British Columbia consist of a mix of for-profit, not-for-profit non-government, and not-for-profit health-region-owned establishments.  This study assesses the extent to which staffing levels have changed by facility ownership category.

Data and methods

With data from Statistics Canada's Residential Care Facilities Survey, various types of care hours per resident-day were examined from 1996 through 2006 for the province of British Columbia.  Random effects linear regression modeling was used to investigate the effect of year and ownership on total nursing hours per resident-day, adjusting for resident demographics, case mix, and facility size.

Results

From 1996 to 2006, crude mean total nursing hours per resident-day rose from 1.95 to 2.13 hours in for-profit facilities (p=0.06); from 1.99 to 2.48 hours in not-for-profit non-government facilities (p<0.001); and from 2.25 to 3.30 hours in not-for-profit health-region-owned facilities (p<0.001). The adjusted rate of increase in total nursing hours per resident-day was significantly greater in not-for-profit health-region-owned facilities.

Interpretation

While total nursing hours per resident-day have increased in all facility groups, the rate of increase was greater in not-for-profit facilities operated by health authorities.

Keywords

aged, frail elderly, geriatrics, geriatric nursing, homes for the aged, nursing care, nursing homes, nursing staff

Findings

Long-term care facilities (nursing homes) provide housing, support and direct care to frail seniors who are unable to function independently. Nursing care in these facilities is provided by a combination of registered nurses (RNs), licensed practical nurses (LPNs), and resident care aides. Higher total nursing and RN hours per resident day have been associated with better care. Thus, nursing hours per resident-day is considered to be one reasonable measure of nursing home quality.[Full text]

Authors

Margaret J. McGregor (1-604-827-4129; mrgret@interchange.ubc.ca) and Michelle B. Cox are with the Department of Family Practice Research Office at the University of British Columbia, Vancouver, British Columbia V5Z 1L8. Robert B. Tate is with the Department of Community Health Sciences at the University of Manitoba. Lisa A. Ronald is with the Centre for Clinical Epidemiology and Evaluation at the Vancouver Coastal Health Research Institute. Kimberlyn M. McGrail and Anne-Marie Broemeling are with the UBC Centre for Health Services and Policy Research. Whitney Berta is with the Department of Health Policy, Management and Evaluation at the University of Toronto.

What is already known on this subject?

  • American studies have found that not-for-profit ownership of nursing homes is associated with higher staffing levels, lower staff turnover, and better outcomes on a range of measures, compared with for-profit-ownership. 
  • Differences in the market mix may limit the generalizability of American findings to Canada.
  • Only three Canadian studies have quantitatively examined associations between long-term care facility staffing levels and facility ownership, and the results have not been consistent.
  • Seniors living in long-term care facilities today are older, more disabled and closer to the end of life than were residents a decade ago, but data on nursing home staff have not been examined over time. 

What does this study add?

  • Total nursing hours per resident day have increased over the past decade for all facility ownership groups in British Columbia.
  • The rate of increase in not-for-profit facilities owned by a health region was significantly greater compared with for-profit facilities.
  • Total nursing hours per resident day were also significantly lower in for-profit facilities, compared with not-for-profit facilities.

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