Outcomes of Minnesota Nursing Home Residents and Their Relationship to Facility Structural and Process-related Attributes

Abstract

The purpose of this research was to observe outcomes of Minnesota nursing home residents admitted from 1988 through 1990 and identify the relationship these outcomes had to selected facility structural and process-related attributes of care. A literature review supported assumptions that nursing home care should be aimed toward assisting residents to achieve the highest possible level of independence and that a greater amount of licensed nursing hours may lead to beneficial outcomes for nursing home residents.

This retrospective study examined the effects of selected Minnesota nursing home attributes (size, ownership, noncompliance with a state correction order, and intensity of licensed nursing hours) on specific resident outcomes (functional ability, discharge home, and death), controlling for age and previous functional ability. The following hypothesis was tested: Improved functional ability and discharge home are more likely to occur as a result of a higher intensity of licensed nursing hours in Minnesota nursing homes.

The functional outcome was operationalized by calculating the resident's Total Dependence Score (TDS), the total score on the assessment of eight Key Activities of Daily Living (score range: 0-33). The residents followed were 65 years of age or older and lived in most of the 440 nursing homes in Minnesota.

Least squares regression analysis was used to estimate the effects of facility attributes, admission TDS, and age on resident outcomes and nonlinear probability analyses to estimate the effects of facility attributes, admission TDS and age on the probability of death or discharge home. In the year after admission, a higher intensity of licensed nursing hours was significantly related to improved functional ability, increased probability of discharge home, and decreased probability of death, supporting the use of more licensed nurses in the nursing home setting.