Labor Prices and the Treatment of Nursing Home Residents with Dementia

Abstract

An important aspect of dementia care for nursing home residents is the management of symptoms such as behavioral problems and wandering. Nursing homes can manage these symptoms using a mix of labor, medications and physical restraints. Medications such as antipsychotics are hypothesized to be a substitute for direct care staff, while physical restraints are considered to be a complement to staff time. Using an instrumental variables approach, we investigate whether an increase in nursing home wages leads to greater substitution towards antipsychotic medications and away from the use of physical restraints. Our results suggest a 10% increase in weekly nursing home wages increases the inappropriate use of antipsychotics among dementia patients by 1.1% to 3.5%, while it decreases the use of physical restraints by roughly 26% to 28%. These findings suggest policymakers should consider nursing home market factors when overseeing and regulating issues of nursing home quality.Factor Substitution, Nursing Homes, Long-Term Care,

Private Investment Purchase and Nursing Home Financial Health

“…First, we reestimated our models by including two state‐level regulatory measures: the state minimum staffing standard (Grabowski et al. ) and the Medicaid payment rate (Grabowski et al. ).…”

“…All of these results, available in the online appendix (see Tables S2-S4), are consistent with the primary findings of our study. First, we reestimated our models by including two state-level regulatory measures: the state minimum staffing standard (Grabowski et al 2011) and the Medicaid payment rate . Second, we constructed an alternate comparison group based on a 10 : 1 propensity score matching algorithm.…”

Antipsychotic medication use in nursing homes: a proposed measure of quality

“…In 2005, the FDA issued a public health advisory cautioning that second-generation APMs are associated with increased mortality risk for persons with dementia (Kuehn, 2005), and this was extended to conventional APMs in 2008 (Schneeweiss et al, 2007). Despite the accumulating evidence of significant harms, only modest effectiveness, and deleterious consequences of inappropriate APM use in NH residents (AGS, 2003(AGS, , 2011Liperoti et al, 2003;Jeste, 2008;Simoni-Wastila et al, 2009), overall rates of use remain high (Crystal et al, 2009) and have undergone only a modest decline in the wake of the FDA's warnings (Gerhard et al, 2008;Grabowski et al, 2011;Kales et al, 2011).…”

Nursing Home Staffing Requirements and Input Substitution: Effects on Housekeeping, Food Service, and Activities Staff

“…; Kim, Harrington, and Greene ; Park and Stearns ; Bowblis ; Grabowski et al. ; Tong ). While regulation affects quality to varying degrees, few papers focus on how NH regulation affects aspects of managing NHs that are not the direct intent of the regulation.…”

“…Numerous studies focus on the effects of regulation on NH quality: use of Medicaid reimbursement Mor et al 2011), regulatory stringency and deficiencies measures (Bowblis et al 2012;Mukamel et al 2012), and minimum staffing requirements (Mueller et al 2006;Kim, Harrington, and Greene 2009;Park and Stearns 2009;Bowblis 2011;Grabowski et al 2011;Tong 2011). While regulation affects quality to varying degrees, few papers focus on how NH regulation affects aspects of managing NHs that are not the direct intent of the regulation.…”