How Neighborhood Social Deprivation Is Associated With Nursing Home Quality: A Structure, Process, Outcome Model

Overview

Journal Innov Aging

Publisher Oxford University Press

Specialty Geriatrics

Date 2025 Feb 18

PMID 39963524

Authors

Rohit Pradhan

Justin Lord

Gregory Orewa

Ganisher Davlyatov

Robert Weech-Maldonado

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Nursing home (NH) quality often varies across socioeconomic gradients. The purpose of this study was to explore the relationship between social deprivation and NH quality.

Research Design And Methods: Integrating resource dependence theory with Donabedian's structure-process-outcome model, this study utilized 2019 data from Payroll Based Journal, Care Compare: Five-Star Quality Rating System, and LTCFocus.org. The analytic file included 12,900 free-standing NH observations. The primary variable of interest was severe social deprivation index (SDI) defined as SDI ≥85/100. Structural equation modeling was used to explore the effects of severe deprivation on NH structural (nursing staff), processes (antipsychotic medications [APMs]), and outcomes (falls, pressure ulcers, activities of daily living [ADL] decline, and hospitalizations) quality indicators among long-stay NH residents.

Results: Nursing homes in communities with severe SDI showed a decrease of 0.02 registered nurse (RN) hours per resident day (PRD) ( < .001) and an increase of 0.03 certified nursing assistant (CNA) hours PRD ( = .01). Higher licensed practical nurse (LPN) hours PRD (β = -1.03; = .003) and higher CNA hours PRD (β = -0.80; < .001) were significantly associated with reduced APM use. Increased APM use was significantly associated with ADL decline (β = 0.03; < .001) and hospitalizations (β = 0.001; = .013). Severe SDI indirectly resulted in higher hospitalizations (β = 0.01; = .01) and falls (β = 0.01; = .001) through lower RN staffing but lower pressure ulcers (β = -0.07; < .001) through higher CNA staffing. Directly, severe SDI increased pressure ulcers (β = 0.69; < .001) and hospitalizations (β = 0.09; < .001) and decreased falls (β = -0.53; < .001).

Discussion And Implications: Severe social deprivation affected nursing staff patterns, affecting care quality. These findings highlight the importance of considering environmental factors in the NH quality policymaking process.

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