Licensed nurse staffing and health service availability in residential care and assisted living

Objectives: To create data-driven typologies of licensed nurse staffing and health services in residential care and assisted living (RC/AL).

Design: Cluster analysis was used to describe the patterns of licensed nurse staffing and 47 services and the extent to which these clusters were related.

Setting: RC/AL communities in the United States.

Participants: A convenience sample of administrators and healthcare supervisors from 89 RC/AL communities in 22 states.

Measurement: RC/AL characteristics, licensed nurse staffing (total number of hours that registered nurses (RNs) and licensed practical nurses (LPNs) worked), number of hours that contract nurses worked, and availability of 47 services.

Results: Analysis revealed four licensed nurse staffing clusters defined according to total number of hours and the type of nurse providing the hours (RN, LPN, or a mix of both). They ranged from no or minimal RN and LPN hours to high nursing hours with a mix of RNs and LPNs. The 47 services clustered into five clusters: basic services; technically complex services; assessments, wound care, and therapies; testing and specialty services; and gastrostomy and intravenous medications. The availability of services was related to the presence of nurses (RNs and LPNs) except for the gastrostomy and intravenous medication services, which were not readily available.

Conclusion: The amount and skill mix of licensed nurse staffing varies in RC/AL and is related to the types of services available. These findings may have implications for resident care and outcomes. Future work in this area, including extension to include nonnurse direct care workers, is needed.