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

Abstract

Objective. To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Data Sources. Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Study Design. Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. Data Extraction Method. OSCAR surveys from 1999 to 2004. Principal Findings. Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Conclusions. Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. Key Words. Nursing homes, regulation, staffing requirements, support staff, housekeeping, food service, activities staff Nurse staffing is an important input in the production of high-quality nursing home (NH) care. Responding to concerns about inadequate nurse staffing levels, between 1999 and 2004, 14 states enacted or strengthened minimum nurse staffing policies. Without nurse staffing requirements, NH administrators choose the optimal amount of nurse staff and non-nurse inputs that maximize the facility's objectives. While requirements may guarantee a minimum level of nurse staff availability, administrators face resource constraints and increases in requirements may cause reductions in the use of non-nurse inputs. This substitution of inputs is likely to result in reduced employment of support staff, such as housekeepers, food service, and activities workers. This article studies whether NHs engage in input substitution by using fewer support staff after changes in nurse staffing requirements.

Staff mix and nursing home quality by level of case mix in Korea

“…Obtaining the best arrangement should be researched from the perspective of staff mix and quality of care. However, identifying the relationship between the two variables without distinction between the case mix of a resident's care demand and nursing home function has only limited explanatory power . Therefore, in the present study, the association between staff mix and quality of care considering case mix was examined in >29 beds.…”

“…However, identifying the relationship between the two variables without distinction between the case mix of a resident's care demand and nursing home function has only limited explanatory power. 14 Therefore, in the present study, the association between staff mix and quality of care considering case mix was examined in >29 beds. We found that there was no significant difference between staff mix and quality of care through univariate analysis, but the multivariate analysis with adjusted facility characteristics showed a significant association.…”

“…Under various economic and regulatory restrictions, nursing homes choose an optimal input mix . Many studies have reported that higher staffing levels increase the quality of care, but coordination cannot be guaranteed, even with higher staffing levels, if the caregiver does not provide care appropriately for each resident's needs .…”

“…The standard also requires at least one social worker for making care plans for residents and consulting with family . A previous study showed that simply requiring one standard by law on staffing without considering the various degrees of case mix in each nursing home can affect the management of nursing homes . In addition, another study suggested that resident acuity has to be considered when setting the staffing standard of nursing homes, because the case mix might be different between nursing homes .…”

The effect of political control on financial performance, structure, and outcomes of US nursing homes

“…With our study on political control, we complement studies that analyze the effect of distinct policy initiatives, such as the effect of minimum staffing standards, certificate‐of‐need regulations, and reimbursement changes . In comparison with those studies, we analyze the full range of Republican and Democratic possibilities for policy making and how these affect the NH industry.…”