Nursing Home Staffing Levels and Resident Health Outcomes: Is the Role of the Physical Therapist Undervalued?

To assess the relationship between nursing home staffing levels and excess outpatient emergency department visits by residents. A retrospective analysis of nursing home facility-level data. 14,860 Medicare- and Medicaid-certified long-term care facilities in the United States. Using publicly available data from the Centers for Medicare & Medicaid (CMS) database for the period October 1, 2022, to September 30, 2023, we used linear regression analysis to assess the association between facility-level rates of excess outpatient emergency department visits by residents and staffing hours per resident per day for physical therapists, registered nurses, nurse aides, and licensed practical nurses, controlling for other facility characteristics. For long-stay residents, an increase in physical therapist (PT) hours per resident per day was negatively associated with excess ED utilization (-0.58 per 1000; 95% Confidence Interval (CI): -0.91 to -0.25, p < 0.001). Similarly, registered nurse (RN) hours per resident per day were significantly associated with a decrease in excess ED utilization (-0.27 per 1000; 95% CI: -0.35 to -0.19, p < 0.001). For short-stay residents, while RN hours showed a significant negative association (-0.69 percent, 95% CI: -1.03 to -0.35, p < 0.001), PT hours did not reach statistical significance (-0.88 percent, 95% CI: -2.36 to 0.60). Nurse aide (NA) and licensed practical nurse (LPN) hours did not significantly correlate with excess visits for long- and short-stay residents. The findings underscore the significance of an optimal combination of nursing home staff to reduce excess outpatient ED visits, particularly for long-stay residents. They point to the need for policy measures that promote balanced staffing levels across different roles to effectively minimize excess outpatient emergency department visits by residents.