Long-Term Care Staffing: Associations with Facility Characteristics, Residents’ Experience, and Quality Measures

Objectives

In October 2022, Australia introduced individual targets for total care and registered nurse (RN) minutes for long-term care facilities based on the assessed care needs of their residents. This study examined associations between facility characteristics and the extent to which care minute targets are met, and determined whether care minutes were associated with residents’ experience and quality measures.

Design

Ecological cross-sectional study using pooled publicly available data from 5 quarterly reporting periods between January-March 2023 and January-March 2024.

Setting and Participants

A total of 2292 long-term care facilities in Australia.

Methods

Generalized linear mixed models were used to examine associations between facility characteristics (ownership type, size, location) and target care minutes met (total and RN minutes). Logistic regression and ordered beta regression models were used to investigate associations between care minutes and residents’ experience and quality measures (pressure injuries, restrictive practices, unplanned weight loss, falls, medication management).

Results

The proportion of facilities meeting or exceeding their total care minutes target (≥100% of target) increased from 41% (n = 938) in the first reporting period to 53% (n = 1213) in the most recent period. Compared with government ownership, for-profit and not-for-profit ownership were associated with lower percentages of target care minutes met (rate ratio, 0.76; 95% CI, 0.75-0.78; and rate ratio, 0.82; 95% CI, 0.80-0.83, respectively). For-profit and not-for-profit ownership, larger facility size, and rural or socioeconomically disadvantaged location were associated with lower percentages of target RN minutes met. No statistically significant associations were identified between care minutes and residents’ experience or quality measures.

Conclusions and Implications

Variation in meeting target care minutes was observed by different facility characteristics. However, no associations between care minutes and residents’ experience or quality measures were observed. Further research should examine care minutes in addition to other factors impacting care quality including staff training, turnover, skills mix, and models of care.