# Nursing home staffing and operations in Taiwan and the United States: A comparative pilot study

## TL;DR

This study compares nursing home staffing and operations in the U.S. and Taiwan, highlighting differences in staffing ratios, medication systems, and staff training.

## Contribution

The paper presents a novel comparative pilot study examining nursing home operations in two distinct healthcare systems.

## Key findings

- U.S. nursing homes had better staffing ratios and electronic medication systems compared to Taiwan's manual processes.
- Staff training was systematic in the U.S. but limited in Taiwan, affecting operational efficiency.
- Post-pandemic staff turnover patterns differed significantly between the two regions.

## Abstract

: The global aging population has precipitated a surge in demand for long-term care, particularly in nursing homes. While the United States operates under a multipayer system, Taiwan utilizes a single-payer National Health Insurance program supplemented by Long-Term Care 10-year plan 3.0. Despite these systemic differences, both nations face critical workforce challenges. This study explores how these distinct frameworks influence nursing home operations, specifically comparing workforce characteristics, staffing practices, and medication safety protocols.

: This was a comparative, descriptive, qualitative pilot study.

: Data were collected between December 2022 and May 2023 at two hospital-affiliated nursing homes in the Northeastern United States and three Christian hospital-affiliated nursing homes in Central Taiwan. Data included direct observations and semi-structured interviews with 34 nursing staff (12 U.S., 22 Taiwan). Thematic analysis and descriptive statistics were used.

: Both participating Nursing homes experienced significant staffing shortages, although ratios differed (U.S. sites: 1:20–30; Taiwan sites: 1:30–40). Resident profiles varied: U.S. sites managed diverse populations, while Taiwan sites served homogeneous residents. U.S. sites employed electronic medication systems with clear error reporting, whereas Taiwan sites relied on inefficient manual, paper-based protocols. Staff training was systematic at the U.S. sites but limited at the Taiwan sites. Notably, COVID-19 attrition patterns diverged: at U.S. sites, turnover was immediate due to burnout, whereas at Taiwan sites, resignations were delayed and post-pandemic.

: Systemic and cultural contexts profoundly influence NH operations. While U.S.A. sites benefit from technology and standardized training, Taiwan sites require technological adoption to improve medication safety and workflow efficiency. These preliminary findings highlight critical targets for improvement and establish a foundation for future, larger-scale research to enhance resident care quality and the work-life balance of nursing staff globally.