The effect of state-specific staffing regulation on quality of care in nursing homes

To identify factors that can potentially improve quality of nursing home care, this project examines input quality as measured by staffing levels and outcome quality. The aim of this research project is to investigate (1) whether differences in statutory staffing requirements lead to regional differences in staff coverage in nursing homes and (2) whether higher statutory requirements lead to higher outcome quality (e.g. less medication or hospital admissions). To estimate the effect of staffing levels on outcome quality, the project will exploit exogenous changes in regulations regarding minimum staffing requirements as well as differences in regulation between states and over time as instrumental variables. The results will provide important evidence to policymakers on the expected consequences of the new uniform staffing regulations that are required by the Long-Term Care Strengthening Act (PSG II).