The Relationship Between Quality of Care, Physical Therapy, and Occupational Therapy Staffing Levels in Nursing Homes in 4 Years’ Follow-up

Objectives: To understand physical therapy (PT) and occupational therapy (OT) staffing levels in nursing homes and to examine their relationship with quality of care. Design: Observational study that used 4 secondary data sources to perform facility-level panel data analyses. Setting and participants: For-profit and nonprofit US nursing homes participating in Medicare and/or Medicaid. The final analytic sample includes 42,374 observations from 12,352 nursing homes, 2013-2016. Methods: Three Centers for Medicare & Medicaid Services quality measures, including activities of daily living (ADL), falls, and 5-star quality, were used to examine the association between PT/OT staffing and quality. Bivariate analyses between PT/OT staffing and facility-level characteristics were run to describe the staffing disciplines in this setting. F tests and t tests were used to test for significance of each relationship. The sample was stratified into quintiles to determine if nursing homes with higher PT/OT staffing levels were linked to higher quality. Significance was determined using F tests and chi-squared tests. Finally, multilevel random effects regressions were performed to examine the relationship between PT/OT staffing and quality. Results: Bivariate analyses indicate that PT/OT staffing levels vary across several nursing home characteristics. After stratifying the sample based on staffing levels, this study found that nursing homes that differ in staffing levels also differ in their quality performance. The random effects regression models also estimated a significant, positive relationship between higher staffing levels and quality, evidenced by each quality domain. Conclusions/Implications: The findings demonstrate that PT/OT staffing may be important components in improving long-stay resident outcomes and overall quality. Evidence was found in support of utilizing a combination of both PT/OT staff and nursing staff to improve resident outcomes, and expanding coverage of these staff/services under Medicaid. Further research should evaluate effective multidisciplinary approaches to care to lend further support to policy makers and progress quality improvement strategies.