CMAJ • August 30, 2005; 173 (5). doi:10.1503/cmaj.1050127.
© 2005 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

Staffing levels for long-term care

Margaret J. McGregor*, Marcy Cohen{dagger} and Kimberlyn McGrail{ddagger}

Department of Family Practice, University of British Columbia;* Canadian Centre for Policy Alternatives;{dagger} Centre for Health Services and Policy, Research, University of British Columbia, Vancouver, BC{ddagger}

Ed Helfrich writes that the staffing levels in our study1 appear too high. However, the "funding model" to which he refers relates to funding (not staffing) guidelines developed over a decade ago by the BC Ministry of Health.2 At the time of our study each facility was receiving a global budget and could decide how to allocate the money among staffing, administration and property costs. Our findings suggest that, with the same funding from government, not-for-profit facilities decided to allocate more of their resources to staffing than did for-profit facilities.

In addition, the funding guideline of 2.83 staff hours per resident-day applies only to "intermediate care III" residents. The same guidelines suggest 3.1 hours per resident-day for more debilitated "extended care" residents. These latter residents would partly account for the higher average staffing hours for this facility designation, as would the decision of not-for-profit facilities to put relatively more money into staffing.

Helfrich speculates that we might have used data for paid rather than worked hours. The staffing levels obtained from the BC Labour Relations Board represent counts of full-time and part-time staff positions, and the expectation is that people are replaced by casual staff for vacation and sick time. In addition, all facilities operated under a master contract with the same wages and benefits. We have no reason to believe that for-profit facilities were less likely than not-for-profit ones to replace people on sick leave or vacation.

Finally, Helfrich makes the point that if valid conclusions are to be drawn about the overall impact of staffing, this measure must be tied directly to outcomes and user satisfaction. Although there is a substantial body of published research supporting the measurement of staffing as a recognized "structural" indicator of nursing home quality,3,4 we were careful in our article to also make this point. We hope that our study will encourage further Canadian research on this question.

Footnotes

Competing interests: Marcy Cohen is a researcher for the Health Employees Union (formerly the Hospital Employees Union). None declared for Drs. McGregor and McGrail.


References

  1. McGregor MJ, Cohen M, McGrail K, Broemeling AM, Adler RN, Schulzer M, et al. Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter? CMAJ 2005;172(5):645-9.[Abstract/Free Full Text]
  2. Funding and Support, Continuing Care Branch. Residential care grant funding system. Victoria: Ministry of Health; 1994.
  3. Hillmer MP, Wodchis WP, Gill SS, Anderson GM, Rochon PA. Nursing home profit status and quality of care: Is there any evidence of an association? Med Care Res Rev 2005;62(2):139-66.[Abstract/Free Full Text]
  4. Harrington C, Zimmerman D, Karon SL, Robinson J, Beutel P. Nursing home staffing and its relationship to deficiencies. J Gerontol B Psychol Sci Soc Sci 2000;55(5):S278-87.




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