Cost analysis of nursing home registered nurse staffing times

OBJECTIVES: To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. DESIGN: A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. SETTING: Eighty-two nursing homes throughout the United States. PARTICIPANTS: One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. MEASUREMENTS: Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. RESULTS: Analyses showed an annual net societal benefit of $3,191 per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. CONCLUSION: Increasing nurse staffing in nursing homes may create significant societal cost savings from re-auction in adverse outcomes. Challenges in increasing nurse staffing are discussed.