Choi JL, Lepore M, Trinkoff AM, Cooke CE, Mattingly TJ 2nd.
Impact of an Artificial Intelligence and Machine Learning Enhanced Electronic Health Record System on Quality Measures in Nursing Homes: A Difference-in-Differences Analysis
Skilled Nursing Facility Value-Based Purchasing Failed To Achieve Hospital Readmission Reductions And Other Targets
Impacts of Skilled Nursing Facility Change of Ownership on Staffing: A Staggered Difference-in-Difference Analysis
The Impact of Nursing Staff Wages on Nursing Home Quality: An Instrumental Variable Approach
Association of initiating CYP2D6-metabolized opioids with risks of adverse outcomes in older adults receiving antidepressants: A retrospective cohort study
Moderators of Adherence Within a Nursing Home Pragmatic Trial of Personalized Music
Cumulative Disadvantages in Nursing Home COVID-19 Infections and Deaths: Implications of Ownership Status and Location
Assessing Facility, Resident, and Financial Characteristics Associated with HUD 232-Sponsored Loan Participation in Nursing Homes.
Resident and Nursing Home Factors Associated With Adherence to a Personalized Music Intervention: Secondary Analyses From Music & MEmory: A Pragmatic TRial (METRIcAL)
Rural hospital closures and nursing home outcomes
Effects of Visitation Restriction on Antipsychotic Drug Use among Nursing Home Residents with ADRD during the COVID-19 Pandemic
The effects of the Patient Driven Payment Model (PDPM) and COVID-19 on nursing and therapy staffing levels among skilled nursing facilities
Medicaid Home and Community Based Services Spending and Nursing Home Use by Individuals Under the Age of 44
Hospital and Skilled Nursing Facility Networks: Informal Relationships and Their Role in the Placement of Traditional Medicare Beneficiaries With Serious Mental Illness
Estimating Cost Savings of Care Coordination for Older Adults: Evidence from the Iowa Return to Community Program
How Neighborhood Social Deprivation Is Associated With Nursing Home Quality: A Structure, Process, Outcome Model
Association of Racial and Ethnic Composition With Staff Levels in Nursing Homes: 2013-2019
Kang Y, Kang S, Bowblis JR, Downer B, McHugh MD, Xu H
Objectives: The nursing home (NH) population has become increasingly diverse, yet many facilities remain de facto racially segregated. This study examines whether a high proportion of Black, Indigenous, and People of Color (BIPOC) residents is associated with nursing staff levels.
Design: We constructed a longitudinal cohort of NHs (2013-2019) by linking Certification and Survey Provider Enhanced Reports, LTCFocUS.org, Medicare Cost Reports, and Payroll-Based Journal data. Separate multivariable random effects linear regressions were conducted.
Setting and participants: 14,075 Medicare- and Medicaid-certified NHs in the United States.
Methods: The proportion of BIPOC residents was categorized as the 10% of nursing homes serving the highest minority residents in each state each year (High-BIPOC) and the remaining 90% (Low-BIPOC). Total nursing staff levels in hours per resident-day (HPRD) included both hours paid (2013-2019) and hours worked (2017-2019). The total staff included registered nurses, licensed practical nurses, and certified nurse aides.
Results: The unadjusted difference in total staff levels between High-BIPOC and Low-BIPOC NHs increased from -0.23 HPRD (4.19 vs 4.42) in 2013 to -0.35 HPRD (3.94 vs 4.29) in 2019 for hours paid. The difference in hours worked increased from -0.19 (3.55 vs 3.74) in 2017 to -0.23 (3.50 vs 3.73) in 2019. The difference became smaller but remained significant after controlling for covariates (-0.037 HPRD for hours paid, and -0.038 for hours worked). Analyses of individual staff types found lower levels of registered nurses and certified nurse aides (but not licensed practical nurses) among High-BIPOC nursing homes. Findings were robust to treating racial and ethnic composition as a continuous variable or excluding payer mix from the models.
Conclusions and implications: NHs with high concentrations of minority residents reported lower nursing staff levels. Improving staffing in NHs serving primarily marginalized racial and ethnic groups remains a policy priority.