Recently, the Centers for Medicare & Medicaid Services (CMS) introduced staffing measures related to staffing variability and turnover in the Nursing Home (NH) Care Compare Five-Star Quality Rating System. While the consensus within the literature is that reduced variability and turnover are associated with higher NH quality of care and life, no existing studies have evaluated the relationship between CMS’s newly introduced staffing measures and quality. This study uses regression analysis to estimate the relationship between 13 quality measures (used in Care Compare) and CMS’s new staffing measures (i.e., weekend nursing staff levels, total nursing and registered nurse staff turnover, and administrator turnover) as well as a measure of daily staffing variation recently introduced in the literature called the coefficient of variation. Regressions analysis finds strong evidence of an association between quality and these staffing measures, though some measures (e.g., nursing staff turnover) are highly correlated and may be duplicative.
AntwiY. A.BowblisJ. R. (2018). The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the great recession. American Journal of Health Economics, 4(2), 131–163. https://doi.org/10.1162/ajhe_a_00096
2.
BackhausR.VerbeekH.van RossumE.CapezutiE.HamersJ. P. H. (2014). Nurse staffing impact on quality of care in nursing homes: A systematic review of longitudinal studies. Journal of the American Medical Directors Association, 15(6), 383–393. https://doi.org/10.1016/j.jamda.2013.12.080
3.
BowblisJ. R.BruntC. S.XuH.GrabowskiD. C. (2023). Understanding nursing home spending and staff levels in the context of recent nursing staff recommendations. Health Affairs, 42(2), 197–206. https://doi.org/10.1377/hlthaff.2022.00692
4.
BowblisJ. R.RobertsA. R. (2020). Cost-effective adjustments to nursing home staffing to improve quality. Medical Care Research and Review, 77(3), 274–284. https://doi.org/10.1177/1077558718778081
5.
BruntC. S. (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 rating downgrade policy. Health Economics, 32(2), 235–276. https://doi.org/10.1002/hec.4619
6.
CastleN. G. (2011). The influence of consistent assignment on nursing home deficiency citations. The Gerontologist, 51(6), 750–760. https://doi.org/10.1093/geront/gnr068
7.
CastleN. G.AndersonR. A. (2011). Caregiver staffing in nursing homes and their influence on quality of care: Using dynamic panel estimation methods. Medical Care, 49(6), 545–552. https://doi.org/10.1097/MLR.0b013e31820fbca9
8.
CastleN. G.HyerK.HarrisJ. A.EngbergJ. (2020). Nurse aide retention in nursing homes. The Gerontologist, 60(5), 885–895. https://doi.org/10.1093/geront/gnz168
DellefieldM.CastleN.McGiltonK.SpilsburyK. (2015). The relationship between registered nurses and nursing home quality: An integrative review (2008-2014). Nursing Economics, 33(2), 95–108.
15.
GandhiA.YuH.GrabowskiD. C. (2021). High nursing staff turnover in nursing homes offers important quality information: Study examines high turnover of nursing staff at US nursing homes. Health Affairs, 40(3), 384–391. https://doi.org/10.1377/hlthaff.2020.00957
16.
HuangS. S.BowblisJ. R. (2019). Is the quality of nursing homes countercyclical? Evidence from 2001 through 2015. The Gerontologist, 59(6), 1044–1054. https://doi.org/10.1093/geront/gny148
17.
KimH.KovnerC.HarringtonC.GreeneW.MezeyM. (2009). A panel data analysis of the relationships of nursing home staffing levels and standards to regulatory deficiencies. The Journals of Gerontology: Series B, 64B(2), 269–278. https://doi.org/10.1093/geronb/gbn019
18.
KonetzkaT. R.YanK.WernerR. M. (2021). Two decades of nursing home compare: What have we learned?Medical Care Research and Review, 78(4), 295–310. https://doi.org/10.1177/1077558720931652
19.
KunkelM. C.BowblisJ. R.StrakerJ.Van HaitsmaK.AbbottK. M. (2023). Impact of implementing the preferences for everyday living inventory on nursing home survey deficiencies. Journal of the American Medical Directors Association, 24(1), 113–118. https://doi.org/10.1016/j.jamda.2022.10.021
20.
LoomerL.GrabowskiD. C.YuH.GandhiA. (2022). Association between nursing home staff turnover and infection control citations. Health Services Research, 57(2), 322–332. https://doi.org/10.1111/1475-6773.13877
21.
LuS. L. (2012). Multitasking, information disclosure, and product quality: Evidence from nursing homes. Journal of Economics & Management Strategy, 21(3), 673–705. https://doi.org/10.1111/j.1530-9134.2012.00341.x
22.
McGarryB. E.GrabowskiD. C.BarnettM. L. (2020). Severe staffing and personal protective equipment shortages faced by nursing homes during the COVID-19 pandemic. Health Affairs, 39(10), 1812–1821. https://doi.org/10.1377/hlthaff.2020.01269
23.
MukamelD. B.SalibaD.LaddH.KonetzkaR. T. (2022). Daily variation in nursing home staffing and its association with quality measures. JAMA Network Open, 5(3), e222051. https://doi.org/10.1001/jamanetworkopen.2022.2051
24.
MukamelD. B.SalibaD.LaddH.KonetzkaR. T. (2023). Association of staffing instability with quality of nursing home care. JAMA Network Open, 6(1), e2250389. https://doi.org/10.1001/jamanetworkopen.2022.50389
25.
National Academies of Sciences, Engineering, and Medicine. (2022). The national imperative to improve nursing home quality: Honoring our commitment to residents, families, and staff. The National Academies Press. https://doi.org/10.17226/26526
26.
Office of Inspector General, Department of Health and Human Services. (2021). CMS use of data on nursing home staffing: Progress and opportunities to do more (OEI-04-18-00451; p. 46). https://oig.hhs.gov/oei/reports/OEI-04-18-00451.pdf
27.
RobertsT.NoletK.BowersB. (2015). Consistent assignment of nursing staff to residents in nursing homes: A critical review of conceptual and methodological issues. The Gerontologist, 55(3), 434–447. https://doi.org/10.1093/geront/gnt101
XuH.IntratorO.BowblisJ. R. (2020). Shortages of staff in nursing homes during the COVID-19 pandemic: What are the driving factors?Journal of the American Medical Directors Association, 21(10), 1371–1377. https://doi.org/10.1016/j.jamda.2020.08.002
