Background information
The costs of care for the elderly in Sweden amounted to just over SEK 102 billion in 2012, with special housing accounting for around 60% of total expenditure on care for the elderly. The single largest cost item for elderly care - about 60% of total costs - is personnel costs. Costs, staffing and quality are a constant topic of public debate. At present, there are few, if any, studies that investigate how costs and staffing levels relate to, and affect, quality in Swedish elderly care.
Challenge
Sirona was commissioned by the Confederation of Swedish Enterprise to analyze the relationship between costs, quality and staffing in special care homes for the elderly.
Implementation
The study analyzed current data from the National Board of Health and Welfare, Statistics Sweden and SKL (Swedish Association of Local Authorities and Regions) regarding conditions in special care homes for the elderly. The analysis was conducted with multiple linear regressions to estimate the effect of increased staff density on five selected quality measures: two user-perceived and three process-related.
Outcome
The analysis showed that there is a wide variation between municipalities in both cost per user and quality outcomes, with increased costs not appearing to lead to increased quality. The analysis of the relationship between staff density and quality at unit level indicated that there is a small positive and statistically significant relationship between staff density and user-perceived quality. However, no relationship was observed when the degree of fulfillment of process measures was analyzed in relation to staff density. The analysis showed that there were a number of factors affecting quality in units other than staff density, such as caregiver training and staff turnover.
