Revisiting the relationship between nurse staffing and quality of care in nursing homes: An instrumental variables approach |
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| Affiliation: | 1. School of Management, Boston University;2. National University of Singapore;1. Rocky Mountain VHA Medical Center, Aurora, CO, USA;2. University of Colorado School of Medicine, Aurora, CO, USA;3. Providence VHA Medical Center, Long Term Services and Supports Center of Innovation, Providence, RI, USA;4. Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA;1. Indiana University & NBER, United States;2. Emory University & NBER, United States;3. Baylor University, United States;1. College of Nursing, Penn State University, University Park, PA;2. Department of Economics, Miami University, Oxford, OH;3. Department of Economics and Scripps Gerontology Center, Miami University, Oxford, OH;1. Department of Health Sciences, Towson University, Towson, MD, USA;2. Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, MD, USA |
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| Abstract: | ![]()
This paper revisits the relationship between nurse staffing and quality of care in nursing homes using an instrumental variables approach. Most prior studies rely on cross-sectional evidence, which renders causal inference problematic and policy recommendations inappropriate. We exploit legislation changes regarding minimum staffing requirements in eight states between 2000 and 2001 as exogenous shocks to nurse staffing levels. We find that registered nurse staffing has a large and significant impact on quality of care, and that there is no evidence of a significant association between nurse aide staffing and quality of care. A comparison of the IV estimation to the OLS estimation of the first-difference model suggests that ignoring endogeneity would lead to an underestimation of how nurse staffing affects quality of care in nursing homes. |
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| Keywords: | Nurse staffing Quality of care Minimum staffing requirements Instrumental variables |
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