Medicaid in Residential Care. Staffing Characteristics

09/01/2013

Residential care is largely a service provided by direct care staff. Thus, the availability of staff may be an important indicator of how well facilities meet the needs of their residents. The NSRCF asked about the total number of hours of direct resident care each type of staff worked in the past seven days. Work hours were collected for personal care aides, licensed practical nurses/licensed vocational nurses (LPNs/LVNs), registered nurses (RNs), and the administrator, if he or she provides direct care to residents. The survey collected data on the number of hours of direct care provided by administrators because in small facilities--which make up half of RCFs--administrators often provide a substantial portion of direct care to residents. However, because the administrators' hours are estimates of the amount of time they spend on direct care rather than management tasks, their staff hours may be less accurate than for other staff whose sole job is to provide resident care.

Figure 1 provides data on the average number of hours of direct staff care provided in Medicaid and non-Medicaid facilities. Care hours are provided for all staff combined and for four staff categories--RNs, LPNs/LVNs, personal care aides, and administrators. The top chart shows staffing with facilities as the unit of analysis. This chart shows that there are no statistically significant differences in the mean hours of care provided by all direct care staff per resident per day between Medicaid and non-Medicaid facilities at the facility level.

FIGURE 1. Direct Care Staffing: Facility Level and Facilities Where Residents Live, Average Hours per Resident Day, by Medicaid Status 

Facility Level Analysis

FIGURE 1a shows a comparison of the direct care staffing hours per resident per day for all direct care staff, all nursing care staff, personal care aides and administrators.  Data are presented at the facility level and the resident level. BAR CHART: Medicaid Facilities--All direct care staff (4.1), All nursing care (0.2), Personal care aide direct care (2.8), Administrator/Assistant Administrator direct care (1.1); Non-Medicaid Facilities--All direct care staff (4.2), All nursing care (0.3), Personal care aide direct care (3.1), Administrator/Assistant Administrator direct care (0.8).

For the chart on facilities serving any residents on Medicaid, differences are not statistically significant at p<0.05.

Facilities in Which Residents Live

FIGURE 1b shows a comparison of the direct care staffing hours per resident per day for all direct care staff, all nursing care staff, personal care aides and administrators.  Data are presented at the facility level and the resident level.  BAR CHART: Facilities in which Medicaid residents live--All direct care staff (2.5), All nursing care (0.2), Personal care aide direct care (1.9), Administrator/Assistant Administrator direct care (0.4); Facilities in which non-Medicaid residents live--All direct care staff (2.3), All nursing care (0.3), Personal care aide direct care (1.8), Administrator/Assistant Administrator direct care (0.2).

For the chart on facilities where Medicaid and non-Medicaid residents live, all differences are statistically significant at p<0.05 or less.

SOURCE: RTI International analysis of the NSRCF.

The bottom chart in the figure shows the average number of direct care hours per resident per day in the facilities in which residents live. The resident is the unit of analysis in the second chart. Overall, staffing levels for all direct care staff are much lower if the unit of analysis is residents rather than facilities. For facilities in which residents live, the difference in the number of total direct care staff hours by resident Medicaid status is statistically significant but the difference is small (2.5 hours per resident per day for Medicaid residents compared to 2.3 hours per resident per day for non-Medicaid residents).

The figure also shows that, at the facility level, the mean number of personal care aide hours and total nursing care hours (i.e., LPN and RN hours) do not differ by Medicaid status. At the resident level, however, the differences for these staffing categories are statistically significant, with the facilities in which Medicaid residents live having higher average staffing levels. The differences, however, are small: 0.3 hours per resident per day of total nursing care (LPN/LVN and RN) for non-Medicaid residents compared to 0.2 hours per resident per day for Medicaid residents, and 1.9 hours of personal care hours for Medicaid residents compared to 1.8 hours for non-Medicaid residents.

With the facility as the unit of analysis, the average direct care hours per resident per day provided by facility administrators are somewhat higher in Medicaid RCFs (1.1 hours) than in non-Medicaid RCFs (0.8 hours); however, the difference is not statistically significant. This difference also exists in facilities where Medicaid residents live; on average, administrators provide a higher number of hours of direct care per resident per day (0.4 hours per resident per day) than in facilities where non-Medicaid residents live (0.2 hours per resident per day), a statistically significant difference. This difference in administrator hours by Medicaid status likely occurs because a larger proportion of the Medicaid facilities are small facilities, with relatively few staff other than the administrator.

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