Address correspondence to Jeongyoung Park, Ph.D., Postdoctoral Researcher, Division of General Internal Medicine, University of Pennsylvania, 1234 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail: firstname.lastname@example.org. Sally C. Stearns, Ph.D., Associate Professor, is with the Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Effects of State Minimum Staffing Standards on Nursing Home Staffing and Quality of Care
Article first published online: 24 SEP 2008
© Health Research and Educational Trust
Health Services Research
Volume 44, Issue 1, pages 56–78, February 2009
How to Cite
Park, J. and Stearns, S. C. (2009), Effects of State Minimum Staffing Standards on Nursing Home Staffing and Quality of Care. Health Services Research, 44: 56–78. doi: 10.1111/j.1475-6773.2008.00906.x
- Issue published online: 15 JAN 2009
- Article first published online: 24 SEP 2008
- Mandated staffing standards;
- nursing homes;
- quality improvement;
Objective. To investigate the impact of state minimum staffing standards on the level of staffing and quality of nursing home care.
Data Sources. Online Survey and Certification Reporting System (OSCAR) merged with the Area Resource File from 1998 through 2001.
Study Design. Between 1998 and 2001, 16 states implemented or expanded staffing standards in excess of federal requirements, creating a natural experiment in comparison with facilities in states without new standards. Difference-in-differences models using facility fixed effects were estimated to determine the effect of state standards.
Data Collection/Extraction Methods. OSCAR data were linked to the data on market conditions and state policies. A total of 55,248 facility-year observations from 15,217 freestanding facilities were analyzed.
Principal Findings. Increased standards resulted in small staffing increases for facilities with staffing initially below or close to new standards. Yet the standards were associated with reductions in restraint use and the number of total deficiencies at all types of facilities.
Conclusions. Mandated staffing standards affect only low-staff facilities facing potential for penalties, and effects are small. Selected facility-level outcomes may show improvement at all facilities due to a general response to increased standards or to other quality initiatives implemented at the same time as staffing standards.