Scale and skill-mix efficiencies in nursing home staffing: inside the black box

Care workers account for a significant proportion of the total health expenditure in nursing homes and are by far the largest controllable resource. Therefore, determining the appropriate number and type of care workers required plays an important role in the search for more efficiency. This study provides insights into how and why ‘scale of scheduling’ and the enlargement of care workers’ jobs (blending tasks of different qualification levels (QLs)) affect the number and type of staff required to meet the preferences (in terms of day and time) of nursing home residents. The scheduling data for plannable care activities of three separate decision‐making units within a single Dutch nursing home have been analyzed. The results show that in >85% of the examined cases, substantial scale and skill‐mix economies can be achieved. We also found that the correlation between the demand patterns of different types of care tasks is of considerable importance when it comes to possible scale and skill‐mix efficiencies.