OBJECTIVE: To examine the relationships between various components of nursing home staffing (total staffing levels and staff mix, staff turnover, and changes in staffing patterns) to an important measure of quality, risk-adjusted rates of pressure ulcer development. DESIGN, SETTING, AND MEASUREMENTS: Staffing records from 35 Department of Veterans Affairs (DVA) nursing homes were reviewed and nursing home administrators from each of the facilities were interviewed. Incidence rates for pressure ulcers were obtained from DVA's national long-term care database and risk adjusted using patients' baseline characteristics. The relationships of risk-adjusted pressure ulcer rates to staffing patterns were tested. RESULTS: Although there was no linear association between staffing levels and pressure ulcer rates, data analysis revealed a strong trend (P = .07) that among the nursing homes meeting staffing guidelines, 60% were among the best performing. Ten nursing homes reduced staffing levels from their baseline levels at the beginning of the study and/or changed their staffing mix by replacing licensed personnel with nursing assistants. This change was associated with a 2.1% higher rate of pressure ulcer development (P = .004). CONCLUSION: Changes in nursing home staffing patterns (either a decrease in overall staffing levels or a change in staffing mix) are related to the quality of nursing home care. Staff stability is associated with better outcomes.
