The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession

Abstract

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in ABSTRACTWe estimate the causal effect of nurse turnover on mortality and the quality of nursing home care with a fixed effect instrumental variable estimation that uses the unemployment rate as an instrument for nursing turnover. We find that ignoring endogeneity leads to a systematic underestimation of the effect of nursing turnover on mortality and quality of care in a sample of California nursing homes. Specifically, 10 percentage point increase in nurse turnover results in a facility receiving 2.2 additional deficiencies per annual regulatory survey, reflecting a 19.3 percent increase. Not accounting for endogeneity of turnover leads to results that suggest only a 1 percent increase in deficiencies. We also find suggestive evidence that turnover results in lower quality in other dimensions and may increase mortality. An implication of our mortality results is that turnover may be a mechanism for the procyclicality of mortality rates. JEL Classification Codes: I11, J21, E24

Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality

“…While these measures encompass the multidimensional nature of NH quality, are validated by CMS, and are used for public reporting during the study period, examining all deficiency outcomes can obscure the fact that some regulations focus on different aspects of quality that may fall under the responsibilities of a specific type of staff (e.g., sanitation regulations and housekeeping). For this reason, we follow the literature and also present a more nuanced examination of the number of deficiencies and the deficiency score for two broad categories of deficiencies: quality of care and quality of life (Harrington et al, 2000; Kim, Kovner, Harrington, Greene, & Mezey, 2009; Akosa Antwi & Bowblis, 2018). 3 The specific regulatory codes that define each broad categorization are in the Supplemental Appendix Table B (available with the online version of the article).…”

Nursing turnover in a large, rural health system

“…To date, most studies of nursing turnover have been conducted via surveys and interviews, often focusing on nursing care in stand‐alone hospitals or nursing homes 8–11 . Less is known about turnover in rural areas, where inadequate nursing care may have more detrimental effects due to the pronounced provider shortages and higher search costs.…”

“We just get paid for 12 hours a day, but we work 24”: home health aide restrictions and work related stress

“…Changes in HHA regulations have the potential to create misalignment between the intention of these formal caregivers and their ability to provide quality care to the sickest of patients. Job stress and turnover in various healthcare settings has proven to have significant negative impact on patients that depend on these services for quality care [3, 4]. The objective of this study is to explore the impact of state regulations, such as the MLTC program regulations in New York State, on HHA’s perceived ability to provide patient care.…”