Study: staffing level related to resident in-bed time

Nursing Homes, August, 2004 by Douglas J. Edwards

Residents in low-staffed nursing homes could be spending as much as an average of 17 hours a day in bed, according to research by the Borun Center for Gerontological Research published in the June issue of the Journal of the American Geriatrics Society. A low staffing level is the strongest predictor of excessive in-bed time, followed by impairments in residents' functional abilities. More time in bed during the day, the report notes, leads to more daytime sleep, increased social isolation, and less food consumption. Residents in lower-staffed homes were observed in bed an estimated average of five hours a day between 7 a.m. and 7 p.m. (on top of which, according to previous Borun Center research, many residents are put to bed by 7 p.m.). Residents in the high-staffed homes were in bed an estimated average of three daytime hours.

"Short-staffed facilities, arguably the majority of nursing homes, must struggle to meet this challenge," said John F. Schnelle, PhD, director of the Borun Center (a joint venture between the UCLA School of Medicine and the Jewish Home for the Aging of Greater Los Angeles). "But neither predictor--not low staffing levels or high disability levels--justify the excessive in-bed times observed in this study."

"The irony is, this highly regulated industry offers no regulatory advice for getting residents up and out of bed," said lead author Barbara M. Bates-Jensen, PhD, RN, adjunct assistant professor at the UCLA School of Medicine, adding, "Complex questions arise. Should a depressed resident be allowed to stay in bed all day if that's his preference? Most of us would probably agree he shouldn't. But what about a resident who is not depressed but wants to spend most of the day in bed? Balancing resident autonomy against provider beneficence is an ongoing challenge in nursing homes. We need more information to adequately address these complex questions."