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

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.