Online Program

Work-family support and climate impact nursing home care quality: Findings from a mixed method study

Monday, November 2, 2015

Cassandra Okechukwu, ScD, MSN, Social and Behavioral Sciences, Harvard T.H Chan School of Public Health, Boston, MA
Janine Bacic, MS, Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
Amy Ehntholt, MA, Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
Background: Scholars lack clear understanding of challenges faced by managers of low-wage workers in health care settings, and how goals of family-supportiveness align qualitatively and quantitatively with resident care goals.

Methods: We triangulated qualitative interviews of 143 managers with quantitative facility care quality measures and employee data (n=1,216) from 34 nursing homes that participated in the pilot and intervention phases of the Work, Family and Health Study. Marginal structural models controlling for time-varying facility-level and demographic variables estimated impact of family-supportiveness on monthly incidence of five measures of care quality collected in the six months after workers’ assessments.

Results: Thematic analyses of qualitative data revealed that managers operate within the constraints of an industry that simultaneously: (a) pays low wages while employing a population with multiple and unique work-family challenges, and (b) has firmly institutionalized goals of prioritizing resident care and minimizing labor costs. From the managers’ perspectives, institutionalized expectations for care quality are in conflict with being supportive of workers’ family needs. Quantitative analyses demonstrated that family-supportiveness at manager level was associated with statistically significant decreases in monthly incidence of all pressure ulcers (-5.52), stage 2+ pressure ulcers (-1.77), all falls (-6.79), and with injurious events (-8.37); association with falls resulting in injuries was not statistically significant (-2.16; p>0.10). Organizational family-supportiveness significantly predicted all falls (-16.38) and falls resulting in injuries (-9.75) but not other resident outcomes.

Conclusion: Managers framed goals of being family-supportive and ensuring quality care as antithetical; quantitative results reveal that these goals may be related.

Learning Areas:

Occupational health and safety
Public health or related education
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe types of work-family needs managers encounter from their workforce Explain three key issues that impact managers' ability to respond to workers' family needs Discuss how organizational and managerial responsiveness to workers' family needs impacts care quality in nursing homes

Keyword(s): Workforce, Nurses/Nursing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a nurse with a doctoral degree in public health and I have been studying workers in the difference contexts for the past ten years. I also have experience with qualitative data collection and analyses and with quantitative analyses using complex methods of analyses.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.