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Intended and Unintended Consequences of Minimum Staffing Standards for Nursing Homes

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  • Min M. Chen
  • David C. Grabowski

Abstract

Staffing is the dominant input in the production of nursing home services. Because of concerns about understaffing in many US nursing homes, a number of states have adopted minimum staffing standards. Focusing on policy changes in California and Ohio, this paper examined the effects of minimum nursing hours per resident day regulations on nursing home staffing levels and care quality. Panel data analyses of facility‐level nursing inputs and quality revealed that minimum staffing standards increased total nursing hours per resident day by 5% on average. However, because the minimum staffing standards treated all direct care staff uniformly and ignored indirect care staff, the regulation had the unintended consequences of both lowering the direct care nursing skill mix (i.e., fewer professional nurses relative to nurse aides) and reducing the absolute level of indirect care staff. Overall, the staffing regulations led to a reduction in severe deficiency citations and improvement in certain health conditions that required intensive nursing care. Copyright © 2014 John Wiley & Sons, Ltd.

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  • Min M. Chen & David C. Grabowski, 2015. "Intended and Unintended Consequences of Minimum Staffing Standards for Nursing Homes," Health Economics, John Wiley & Sons, Ltd., vol. 24(7), pages 822-839, July.
    • Handle: RePEc:wly:hlthec:v:24:y:2015:i:7:p:822-839
    DOI: 10.1002/hec.3063
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    Cited by:

    1. 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.
    2. David W. Harless, 2019. "Reassessing the labor market effects of California's minimum nurse staffing regulations," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1226-1231, October.
    3. Martin Hackmann & Joerg Heining & Roman Klimke & Maria Polyakova & Holger Seibert, 2021. "General Equilibrium Effects of Insurance Expansions: Evidence from Long-Term Care Labor Markets," Upjohn Working Papers 21-357, W.E. Upjohn Institute for Employment Research.
    4. 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.
    5. Jonathan Gruber & Kathleen McGarry, 2023. "Long-Term Care in the United States," NBER Chapters, in: Long-Term Care around the World, National Bureau of Economic Research, Inc.
    6. Facchini, Gabriel, 2022. "Low staffing in the maternity ward: Keep calm and call the surgeon," Journal of Economic Behavior & Organization, Elsevier, vol. 197(C), pages 370-394.
    7. Mommaerts, Corina & Truskinovsky, Yulya, 2020. "The cyclicality of informal care," Journal of Health Economics, Elsevier, vol. 71(C).
    8. Jun, Hankyung & Grabowski, David C., 2024. "Mental health in nursing homes: The role of immigration in the long-term care workforce," Social Science & Medicine, Elsevier, vol. 351(C).
    9. Susan F. Lu & Huaxia Rui & Abraham Seidmann, 2018. "Does Technology Substitute for Nurses? Staffing Decisions in Nursing Homes," Management Science, INFORMS, vol. 64(4), pages 1842-1859, April.
    10. Dörte Heger & Annika Herr & Anne Mensen, 2022. "Paying for the view? How nursing home prices affect certified staffing ratios," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1618-1632, August.
    11. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2020. "Capacity constraints and time allocation in public health clinics," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 324-336, March.
    12. Matthew C. Harris & Yinan Liu & Ian McCarthy, 2019. "Capacity Constraints and the Provision of Public Services: The Case of Workers in Public Health Clinics," NBER Working Papers 25706, National Bureau of Economic Research, Inc.

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