The effects of staffing on in-bed times of nursing home residents.

OBJECTIVES To examine the effect of staffing level on time observed in bed during the daytime in nursing home (NH) residents. DESIGN Descriptive, cross-sectional study. SETTING Thirty-four southern California NHs. PARTICIPANTS A total of 882 NH residents: 837 had hourly observation data, 777 had mealtime observations, 837 completed interviews, and 817 completed a physical performance test. MEASUREMENTS Cross-sectional data collected from participants at each NH site included direct observations (hourly and mealtime), resident interviews, medical record review, and physical performance tests. RESULTS In multivariate analyses, staffing level remained the strongest predictor of time observed in bed after controlling for resident functional measures (odds ratio=4.89; P=.042). Residents observed in bed during the daytime in more than 50% of hourly observations were observed also to experience increased daytime sleeping (P<.001) and less social engagement (P=.026) and consumed less food and fluids during mealtimes than those observed in bed in less than 50% of observations, after adjusting for resident function (P<.001). CONCLUSION In this sample of NHs, resident functional measures and NH staffing level predicted observed time in bed according to hourly observations, with staffing level the most powerful predictor. Neither of these predictors justifies the excessive in-bed times observed in this study. Staff care practices relevant to encouraging residents to be out of bed and resident preferences for being in bed should be examined and improved. Practice recommendations regarding in-bed time should be considered, and further research should seek to inform the development of such recommendations.