gms | German Medical Science

Background and Purpose: Staffing practices in long-term care lack a clear evidence-base. Therefore, the aim of this literature study was to summarize all available evidence on the relationship between staffing and quality in nursing homes.

Methods: In January and February 2016, a literature study was conducted. We searched scientific databases and Google Scholar for articles published in peer-reviewed scientific journals.

Research Focus: We distinguished between studies that assessed the quantity of staff (i.e., total amount of staff hours per resident) or the educational background of staff. In addition, we distinguished between studies assessing quality of care (e.g., clinical outcomes like pressure ulcers or falls, deficiency citations), quality of life or other outcomes (e.g., resident satisfaction).

Results: In total, 183 studies were included. Based on these studies, no scientific evidence for a positive relationship between staffing levels or educational background of staff and quality in nursing homes was found. Studies that found a positive relationship were mostly conducted in the US and made use of secondary data from databases that are not primarily intended for research purposes. Studies that were conducted outside the US and made use of more reliable databases, often found no relationship.

Conclusions: Probably contrary to existing opinions and beliefs, the evidence for positive relationship between staffing and quality in nursing homes is contradictory. This means that employing more or better educated staff will not automatically lead to better quality and that the evidence base for implementing a generic minimum staffing standard in nursing homes is lacking.