The appropriateness of hospitalization for nursing home (NH) residents is still up for debate, with determining factors including timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues. Although the factors leading to hospitalization have been studied expansively, research on staffing is limited. Thus, this study aimed to investigate organizational predictors, nurse staffing, and government incentives and find important factors to hospitalization due to infection or disease among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022. A total of 32 explanatory variables were included. The response variable was the count of hospitalized residents due to infection or disease. We analyzed data using least absolute shrinkage and negative binomial regression. We found that registered nurses’ increased hours per resident day were related to decreased hospitalizations due to infection or disease. Appropriate retention and recruitment of nurse staffing with professional leadership should be performed to increase the quality of care for NH residents.
AdlbrechtL.BartholomeyczikS.MayerH. (2021). Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care: A process evaluation. BMC Geriatrics, 21, Article 680. https://doi.org/10.1186/s12877-021-02637-5
AshcraftA. S.OwenD. C. (2014). From nursing home to acute care: Signs, symptoms, and strategies used to prevent transfer. Geriatric Nursing, 35(4), 316–320. https://doi.org/10.1016/j.gerinurse.2014.06.007
4.
BackhausR.VerbeekH.van RossumE.CapezutiE.HamersJ. P. (2014). Nurse staffing impact on quality of care in nursing homes: A systematic review of longitudinal studies. Journal of the American Medical Directors Association, 15(6), 383–393. https://doi.org/10.1016/j.jamda.2013.12.080
5.
CadiganR. O.GrabowskiD. C.GivensJ. L.MitchellS. L. (2012). The quality of advanced dementia care in the nursing home: The role of special care units. Medical Care, 50(10), 856–862. https://doi.org/10.1097/mlr.0b013e31825dd713
6.
CastleN. G. (2008). Nursing home caregiver staffing levels and quality of care: A literature review. Journal of Applied Gerontology, 27(4), 375–405. https://doi.org/10.1177/0733464808321596
ChaeH. W.ZhaoJ.AhY. M.ChoiK. H.LeeJ. Y. (2023). Potentially inappropriate medication use as predictors of hospitalization for residents in nursing home. BMC Geriatrics, 23(1), Article 467. https://doi.org/10.1186/s12877-023-04165-w
10.
ChoE.KimE. Y.LeeK. H.KimH. R.ChoiS.YoonY. S.KimE.HeoS. J.JungS. Y.JangJ. (2023). The effects of special nursing units in nursing homes on healthcare utilization and cost: A case-control study using propensity score matching. International Journal of Nursing Studies, 147, 104587. https://doi.org/10.1016/j.ijnurstu.2023.104587
11.
ChoE.KimI. S.LeeT. W.KimG. S.LeeH.MinD. (2020). Effects of registered nurse staffing on quality of care and resident outcomes in nursing homes. Geriatric Nursing, 41(6), 685–691. https://doi.org/10.1016/j.gerinurse.2020.04.001
12.
DownerB.ThomasK. S.MorV.GoodwinJ. S.OttenbacherK. J. (2017). Cognitive status of older adults on admission to a skilled nursing facility according to a hospital discharge diagnosis of dementia. Journal of the American Medical Directors Association, 18(8), 726–728. https://doi.org/10.1016/j.jamda.2017.04.021
13.
DwyerR.StoelwinderJ.GabbeB.LowthianJ. (2015). Unplanned transfer to emergency departments for frail elderly residents of aged care facilities: A review of patient and organizational factors. Journal of the American Medical Directors Association, 16(7), 551–562. https://doi.org/10.1016/j.jamda.2015.03.007
14.
EstradaL.DickA.StoneR. C. P.LawtonA. J. (2023). Potentially avoidable hospitalizations at end of life among historically marginalized residents in nursing homes nationwide (TH122D) #friendtorship: Cultivating peer mentor relationships in hospice and palliative medicine (TH125A). Journal of Pain and Symptom Management, 65(3), E267. https://doi.org/10.1016/j.jpainsymman.2022.12.058
15.
GivensJ. L.SelbyK.GoldfeldK. S.MitchellS. L. (2012). Hospital transfers of nursing home residents with advanced dementia. Journal of the American Geriatrics Society, 60(5), 905–909. https://doi.org/10.1111/j.1532-5415.2012.03919.x
16.
GoelA. V.Rivera-HernandezM. (2023). Quality at nursing homes with high proportion of residents with cognitive impairment. Geriatric Nursing, 50, 65–71. https://doi.org/10.1016/j.gerinurse.2022.12.018
17.
GrabowskiD. C.O’MalleyA. J. (2014). Use of telemedicine can reduce hospitalizations of nursing home residents and generate savings for medicare. Health Affairs, 33(2), 244–250. https://doi.org/10.1377/hlthaff.2013.0922
18.
GrabowskiD. C.StewartK. A.BroderickS. M.CootsL. A. (2008). Predictors of nursing home hospitalization: A review of the literature. Medical Care Research and Review, 65(1), 3–39. https://doi.org/10.1177/1077558707308754
19.
HarringtonC.MollotR.BraunR. T.WilliamsD., Jr. (2023). United States’ nursing home finances: Spending, profitability, and capital structure. International Journal of Social Determinants of Health and Health Services, 54, 131–142. https://doi.org/10.1177/27551938231221509
20.
HoffmannF.AllersK. (2016). Age and sex differences in hospitalisation of nursing home residents: A systematic review. BMJ Open, 6, e011912. https://doi.org/10.1136/bmjopen-2016-011912
21.
HoninxE.PiersR. D.Onwuteaka-PhilipsenB. D.PayneS.SzczerbińskaK.GambassiG.KylänenM.DeliensL.van den BlockL.SmetsT. (2021). Hospitalisation in the last month of life and in-hospital death of nursing home residents: A cross-sectional analysis of six European countries. BMJ Open, 11(8), e047086. https://doi.org/10.1136/bmjopen-2020-047086
22.
JensenP. M.FraserF.ShankardassK.EpsteinR.KheraJ. (2009). Are long-term care residents referred appropriately to hospital emergency departments?Canadian Family Physician, 55(5), 500–505.
23.
JoyceN. R.McGuireT. G.BartelsS. J.MitchellS. L.GrabowskiD. C. (2018). The impact of dementia special care units on quality of care: An instrumental variables analysis. Health Services Research, 53(5), 3657–3679. https://doi.org/10.1111%2F1475-6773.12867
24.
KadaO.JanigH.LikarR.CernicK.PinterG. (2017). Reducing avoidable hospital transfers from nursing homes in Austria. Gerontology and Geriatric Medicine, 3, 233372141769667. https://doi.org/10.1177/2333721417696671
25.
Kajdacsy-Balla AmaralA. C.HillA. D.PintoR.FuL.MorinvilleA.HeckmanG.HébertP.HirdesJ. (2022). The effects of acute care hospitalization on health and cost trajectories for nursing home residents: A matched cohort study. Medicine, 101(41), E31021. https://doi.org/10.1097/MD.0000000000031021
26.
KieftR. A.De BrouwerB. B.FranckeA. L.DelnoijD. M. (2014). How nurses and their work environment affect patient experiences of the quality of care: A qualitative study. BMC Health Services Research, 14, Article 249. https://doi.org/10.1186/1472-6963-14-249
27.
KimN. E.LeeJ. H.ChangJ. H.LeeS. H.RyuY. J. (2021). Clinical characteristics and outcomes among older nursing home residents hospitalized with pneumonia. Archives of Gerontology and Geriatrics, 95, 104394. https://doi.org/10.1016/j.archger.2021.104394
28.
KimK.LeeD. H.YuneH. Y.WeeJ. H.KimD. H.KimE. C.LimJ. Y.ChoiS. P. (2019). Identifying potentially avoidable emergency department visits of long-term care hospital residents in Korea: A multicenter retrospective cohort study. BioMed Research International, 2019, 1–7. https://doi.org/10.1155/2019/7041607
29.
KimW. Y.SuhY.AhY. M.ChoiJ. Y.KimK.LeeJ. Y. (2023). Medication-Related acute care admission and inappropriate polypharmacy of nursing home residents. Journal of the American Medical Directors Association, 24(2), 242–249.e7. https://doi.org/10.1016/j.jamda.2022.11.011
30.
KirsebomM.HedstromM.WadenstenB.PoderU. (2014). The frequency of and reasons for acute hospital transfers of older nursing home residents. Archives of Gerontology and Geriatrics, 58(1), 115–120. https://doi.org/10.1016/j.archger.2013.08.002
31.
KosarC. M.MorV.WernerR. M.RahmanM. (2023). Risk of discharge to lower-quality nursing homes among hospitalized older adults with Alzheimer disease and related dementias. JAMA Network Open, 6(2), e2255134. https://doi.org/10.1001/jamanetworkopen.2022.55134
32.
LagingB.FordR.BauerM.NayR. (2015). A meta-synthesis of factors influencing nursing home staff decisions to transfer residents to hospital. Journal of Advanced Nursing, 71(1), 2224–2236. https://doi.org/10.1111/jan.12652
33.
LaiC. K.YeungJ. H.MokV.ChiI. (2009). Special care units for dementia individuals with behavioural problems. Cochrane Database of Systematic Reviews, 4, Article CD006470. https://doi.org/10.1002/14651858.CD006470.pub2
34.
LeeJ. S.ParkS. H.YooA. J.HanE. J.MoonY. P.ParkS. Y., et al. (2017). A study on the development of skilled nursing care unit model for long-term care institutions. National Health Insurance Service.
35.
LemoyneS. E.HerbotsH. H.De BlickD.RemmenR.MonsieursK. G.Van BogaertP. (2019). Appropriateness of transferring nursing home residents to emergency departments: A systematic review. BMC Geriatrics, 19(1), Article 17. https://doi.org/10.1186/s12877-019-1028-z
36.
ManckoundiaP.MenuD.TurcuA.HonnartD.RossignolS.AlixantJ. C.SylvestreF.-H.BaillyV.DionM.PutotA. (2016). Analysis of inappropriate admissions of residents of medicalized nursing homes to emergency departments: A prospective multicenter study in Burgundy. Journal of the American Medical Directors Association, 17(7), 671.e1–671.e7. https://doi.org/10.1016/j.jamda.2016.04.017
37.
McCarthyE. P.OgarekJ. A.LoomerL.GozaloP. L.MorV.HamelM. B.MitchellS. L. (2020). Hospital transfer rates among US nursing home residents with advanced illness before and after initiatives to reduce hospitalizations. JAMA Internal Medicine, 180(3), 385–394. https://doi.org/10.1001/jamainternmed.2019.6130
38.
MinD.ChoE.KimG. S.LeeK. H.YoonJ. Y.KimH. J.ChoiM. H. (2022). Factors associated with retention intention of registered nurses in Korean nursing homes. International Nursing Review, 69(4), 459–469. https://doi.org/10.1111/inr.12754
39.
MorphetJ.InnesK.GriffithsD. L.CrawfordK.WilliamsA. (2015). Resident transfers from aged care facilities to emergency departments: Can they be avoided?Emergency Medicine Australasia, 27(5), 412–418. https://doi.org/10.1111/1742-6723.12433
40.
MuenchU.SimonM.GuerbaaiR.-A.De PietroC.ZellerA.KressigR. W.ZúñigaF. (2019). Preventable hospitalizations from ambulatory care sensitive conditions in nursing homes: Evidence from Switzerland. International Journal of Public Health, 64(9), 1273–1281. https://doi.org/10.1007/s00038-019-01294-1
41.
MukamelD. B.SalibaD.LaddH.KonetzkaR. T. (2022). Associations between daily nurse staffing levels and daily hospitalizations and ED visits in nursing homes. Journal of the American Medical Directors Association, 23(11), 1793–1799.e3. https://doi.org/10.1016/j.jamda.2022.06.030
PulstA.FassmerA. M.SchmiemannG. (2021). Unplanned hospital transfers from nursing homes: Who is involved in the transfer decision? Results from the HOMERN study. Aging Clinical and Experimental Research, 33(8), 2231–2241. https://doi.org/10.1007/s40520-020-01751-5
46.
RahmanM.GozaloP.TylerD.GrabowskiD. C.TrivediA.MorV. (2014). Dual eligibility, selection of skilled nursing facility, and length of medicare paid postacute stay. Medical Care Research and Review, 71(4), 384–401. https://doi.org/10.1177/1077558714533824
47.
SalibaD.WeimerD. L.ShiY.MukamelD. B. (2018). Examination of the new short-stay nursing home quality measures: Rehospitalizations, emergency department visits, and successful returns to the community. Inquiry, 55, Article 46958018786816. https://doi.org/10.1177%2F0046958018786816
48.
ShinJ. H. (2019). Appropriate nursing home nurse hours per resident day in Korea: A secondary analysis of longitudinal data. Journal of Nursing Scholarship, 51(5), 569–579. https://doi.org/10.1111/jnu.12498
49.
SiegelE. O.KolanowskiA. M.BowersB. J. (2023). A fresh look at the nursing home workforce crisis: Transforming nursing care delivery models. Research in Gerontological Nursing, 16(1), 5–13. https://doi.org/10.3928/19404921-20230104-01
50.
SpilsburyK.HewittC.StirkL.BowmanC. (2011). The relationship between nurse staffing and quality of care in nursing homes: A systematic review. International Journal of Nursing Studies, 48(6), 732–750. https://doi.org/10.1016/j.ijnurstu.2011.02.014
51.
StekhovenD. J.BühlmannP. (2012). Missforest—non-parametric missing value imputation for mixed-type data. Bioinformatics (Oxford, England), 28(1), 112–118. https://doi.org/10.1093/bioinformatics/btr597
52.
Temkin-GreenerH.ZhengN. T.XingJ.MukamelD. B. (2013). Site of death among nursing home residents in the United States: Changing patterns, 2003-2007. Journal of the American Medical Directors Association, 14(10), 741–748. https://doi.org/10.1016/j.jamda.2013.03.00
ThomasK. S.MorV.TylerD. A.HyerK. (2013). The relationships among licensed nurse turnover, retention, and rehospitalization of nursing home residents. The Gerontologist, 53(2), 211–221. https://doi.org/10.1093/geront/gns082
55.
TsaiH.-H.TsaiY.-F.LiuC.-Y. (2016). Repeated hospital transfers and associated outcomes by residency time among nursing home residents in Taiwan. Journal of the American Medical Directors Association, 17(11), 1020–1024. https://doi.org/10.1016/j.jamda.2016.06.019
56.
TylerD. A.FengZ.GrabowskiD. C.BercawL.SegelmanM.KhatutskyG.WangJ.GasdaskaA.IngberM. J. (2022). CMS Initiative to reduce potentially avoidable hospitalizations among long-stay nursing facility residents: Lessons learned. The Milbank Quarterly, 100(4), 1243–1278. https://doi.org/10.1111/1468-0009.12594
57.
UnroeK. T.HickmanS. E.CarnahanJ. L.HassZ.SachsG.ArlingG. (2018). Investigating the avoidability of hospitalizations of long stay nursing home residents: Opportunities for improvement. Innovation in Aging, 2(2), Article igy017. https://doi.org/10.1093/geroni/igy017
58.
WhiteE. M.AikenL. H.SloaneD. M.McHughM. D. (2020). Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction. Geriatric Nursing, 41(2), 158–164. https://doi.org/10.1016/j.gerinurse.2019.08.007
59.
XingJ.MukamelD. B.Temkin-GreenerH. (2013). Hospitalizations of nursing home residents in the last year of life: Nursing home characteristics and variation in potentially avoidable hospitalizations. Journal of the American Geriatrics Society, 61(11), 1900–1908. https://doi.org/10.1111/jgs.12517
60.
ZhangS.GongL.ZengQ.LiW.XiaoF.LeiJ. (2021). Imputation of GPS coordinate time series using missForest. Remote Sensing, 13(12), 2312. https://doi.org/10.3390/rs13122312
