UNC study: Nursing home interventions improve quality of care, reduce staff turnover

Thomas R. Konrad, PhD, research professor of health policy and management at the UNC Gillings School of Global Public Health and a senior scientist at the Institute on Aging, is a co-author of the study.

Previous research has shown that high levels of turnover and worker shortages may compromise both the availability of frontline workers and the quality of care, potentially putting nursing home residents at risk.

The study, conducted in North Carolina nursing homes between 2004 and 2007, examined the impact of three programs funded by civil monetary penalties – funds collected from nursing homes for deficiencies in care.

• The WIN A STEP UP program, which upgrades nursing assistants’ skills, increases their job commitment, and provides rewards and recognition;
• Quality Improvement Collaboratives, in which groups of nursing homes work together with the statewide Quality Improvement Organization to improve specific quality indicators such as reducing pressure sores or the use of restraints;
• Culture Change Initiatives, in which nursing homes change their structures or routines to make their environments more “homelike.”

The report was commissioned by the N.C. Department of Health and Human Services and authored by Konrad, Jennifer Craft Morgan, PhD, and colleagues at the UNC Institute on Aging.

The study found nursing homes that implemented the interventions saw several improvements:

• Facilities using the WIN A STEP UP program saw a decrease in pressure sores among their residents and had lower turnover of direct care workers;
• Homes participating in Quality Improvement Collaboratives exhibited a reduction in incontinence and the use of restraints; and
• Facilities implementing Culture Change Initiatives experienced a reduction in the use of restraints.

“The study shows North Carolina’s unique partnerships between the state, the university and nursing homes are effectively leveraging federal funds to improve the lives of those who live in as well as those who work in nursing homes,” Konrad said.

The report, titled “Workplace Interventions, Turnover and Quality of Care Report,” can be downloaded from the WIN A STEP UP website at http://winastepup.org/reports.

For more information, visit the Institute on Aging website, www.aging.unc.edu.

Konrad can be reached at (919) 244-8659 or bob_konrad@unc.edu.

UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu.