Addressing Staffing Shortages in Nursing Homes: Does Relaxing Training and Licensing Requirements Increase Nurse Aide Staffing?

IF 3.2 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES Health Services Research Pub Date : 2025-02-19 DOI:10.1111/1475-6773.14455

Gulrukh Mehboob, Hari Sharma

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Abstract

Objective

To evaluate whether COVID-19-related nurse aide training and licensing relaxation policies improved staffing shortages in nursing homes.

Study Setting and Design

Staffing shortages have been a long-standing concern in nursing homes, and states are experimenting with different approaches to enhance nurse aide staffing. We use the latest quasi-experimental difference-in-differences methods to evaluate the effect of relaxing training and licensing requirements in 19 states (treatment group) relative to the 31 states that did not implement such policies (control group). We analyze the combined effect of relaxing both training and licensing requirements, as well as the impact of relaxing each policy separately.

Data Sources and Analytic Sample

We obtain quarterly data on nursing home characteristics, including adjusted nurse aide hours per resident day (HPRD) from 2019 to 2023 from Care Compare, a federal website with quality information on all Medicare/Medicaid-certified nursing homes. After excluding outliers of staffing data (nurse aide HPRD > 5.25, or nurse aide HPRD = 0), our final analytical sample had 278,170 observations.

Principal Findings

The average nurse aide HPRD is 2.30 in the treatment group and 2.26 in the control group. Using the difference-in-differences regression analyses, we find no significant effect of the relaxation of training and licensing requirements on nurse aide levels (average treatment effect: −0.0001; p = 0.99). Similarly, separate analyses of training and licensing relaxation policies suggest that neither policy significantly impacts nurse aide staffing. Results are consistent when we adjust for staffing requirements, wage increase policies, and nursing home characteristics.

Conclusions

Our findings suggest that the relaxation of training and licensing requirements may not lead to improved nurse aide staffing levels in nursing homes. Policymakers need to consider other strategies to address persistent staffing shortages in nursing homes.

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解决养老院人员短缺问题：放松培训和执照要求会增加护士助理的人手吗？

目的：评价新冠肺炎相关护士长培训和执照放宽政策是否改善了养老院人员短缺问题。研究设置和设计：人员短缺一直是养老院长期关注的问题，各州正在尝试不同的方法来增加护士助理的人手。我们使用最新的准实验差异中差异方法来评估19个州（治疗组）相对于31个未实施此类政策的州（对照组）放松培训和许可要求的效果。我们分析了同时放宽培训和执照要求的综合效果，以及分别放宽每项政策的影响。数据来源和分析样本：我们从联邦网站Care Compare获取有关养老院特征的季度数据，包括2019年至2023年调整后的每个住院日护理时间（HPRD），该网站包含所有医疗保险/医疗补助认证的养老院的质量信息。在排除人员配置数据的异常值（护士HPRD = 5.25，或护士HPRD = 0）后，我们最终的分析样本有278,170个观察值。主要发现：治疗组护理助理平均HPRD为2.30，对照组护理助理平均HPRD为2.26。使用异中异回归分析，我们发现放松培训和执照要求对护理助理水平没有显著影响(平均治疗效果：-0.0001；p = 0.99)。同样，对培训和许可放宽政策的单独分析表明，这两项政策都不会显著影响护士助理的人员配备。当我们根据人员需求、工资增长政策和养老院的特点进行调整时，结果是一致的。结论：我们的研究结果表明，放松培训和许可要求可能不会导致养老院护理人员配备水平的提高。决策者需要考虑其他策略来解决养老院持续存在的人员短缺问题。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.