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The Impact of Minimum Quality Standard Regulations on Nursing Home Staffing, Quality, and Exit Decisions

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  • John R. Bowblis

    (Miami University)

  • Andrew Ghattas

    (University of Iowa College of Public Health)

Abstract

The regulation of nursing homes in the U.S. often includes mandates that require a minimum nurse staffing level. In this paper, we exploit new minimum nurse staffing regulations by the states of New Mexico and Vermont that were implemented in the early 2000s to determine how nursing homes responded in terms of staffing, quality, and the decision to exit the market. Our identification strategy exploits the fact that some nursing homes had pre-regulatory staffing levels near the new requirement and did not need to change staffing levels. We compare these nursing homes to a group that faced binding constraints (low-staffed) and those that were significantly over the constraint (high-staffed). Low-staffed nursing homes increase staffing levels but also use less expensive nurse types to satisfy the new standard. High-staffed nursing homes decrease staffing and use fewer contracted staff. Overall, dispersion in staffing is reduced, but we find little effect by pre-regulatory staffing level on non-staffing measures of quality and the decision to exit the market.

Suggested Citation

  • John R. Bowblis & Andrew Ghattas, 2017. "The Impact of Minimum Quality Standard Regulations on Nursing Home Staffing, Quality, and Exit Decisions," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 50(1), pages 43-68, February.
    • Handle: RePEc:kap:revind:v:50:y:2017:i:1:d:10.1007_s11151-016-9528-x
    DOI: 10.1007/s11151-016-9528-x
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    References listed on IDEAS

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    Cited by:

    1. John R. Bowblis & Austin C. Smith, 2021. "Occupational Licensing of Social Services and Nursing Home Quality: A Regression Discontinuity Approach," ILR Review, Cornell University, ILR School, vol. 74(1), pages 199-223, January.
    2. Christopher S. Brunt, 2023. "Assessing the impact of enforcement and compliance with minimum staffing standards on the quality of care in nursing homes: Evidence from the Centers for Medicare and Medicaid Services' staff star rat," Health Economics, John Wiley & Sons, Ltd., vol. 32(2), pages 235-276, February.
    3. Samuel Guillemot & Annick Tamaro & Margot Dyen, 2022. "Vital Service Captivity: Coping Strategies and Identity Negotiation," Post-Print hal-03567883, HAL.

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    More about this item

    Keywords

    Minimum quality standards; Regulation; Nursing homes; Nurse staff levels; Nurse staff composition; Exit;
    All these keywords.

    JEL classification:

    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L51 - Industrial Organization - - Regulation and Industrial Policy - - - Economics of Regulation

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