Assessing a Statewide Nursing Home Staffing Program through Quantitative and Qualitative Survey Data

Lindsay J Peterson; Kelly M Smith

doi:10.1016/j.jamda.2025.105517

Assessing a Statewide Nursing Home Staffing Program through Quantitative and Qualitative Survey Data

J Am Med Dir Assoc. 2025 Mar 13;26(5):105517. doi: 10.1016/j.jamda.2025.105517. Online ahead of print.

Authors

Lindsay J Peterson¹, Kelly M Smith²

Affiliations

¹ Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA. Electronic address: ljpeterson@usf.edu.
² Q3 Healthcare Consulting, Riverview, FL, USA.

PMID: 39999954
DOI: 10.1016/j.jamda.2025.105517

Abstract

Objectives: To use quantitative and qualitative data to assess nursing home administrators' perceptions of a program using personal care attendants (PCAs) to ease staffing challenges, and to better understand factors concerning perceptions of success of lack thereof.

Design: Convergent mixed methods design, in which quantitative and qualitative data were collected concurrently and analyzed separately, with results combined for interpretation.

Setting and participants: Florida nursing home administrators (N = 74).

Methods: We developed a survey to collect data on administrators' use and perceptions of the PCA program. Data from closed-end questions assessing the value and use of PCAs and data on nursing home characteristics (eg, bed size, profit status) were analyzed using multiple logistic regression. Open-ended responses were analyzed using deductive thematic analysis. Quantitative and qualitative data were combined for further analysis.

Results: We found greater use of PCAs (more PCAs hired) was associated with 6% greater odds of finding the program beneficial (odds ratio, 1.06; 95% CI, 1.0-1.12; P = .049), controlling for facility characteristics. Qualitative analysis identified 3 themes: benefits of the PCA program, barriers to the success of the program, and steps taken to improve the program's usefulness. In further analysis, we identified an overarching theme of administrator proactivity in the implementation of the PCA program. Integration of quantitative and qualitative results found a relationship between assessing the PCA program as beneficial and taking proactive steps to facilitate use of PCAs.

Conclusions and implications: Success of the PCA program in easing staffing challenges may have depended on administrators being proactive, in contrast to those who negatively assessed the program and took a more passive approach. Results provide evidence of differing leadership styles in the use of the PCA program, suggesting leadership training could better equip nursing home leaders to implement staffing initiatives. More research is recommended on the relationship between administrative leadership, staffing, and quality.

Keywords: Nursing home; administrators; leadership; personal care attendants; staffing.