Factor substitution in nursing homes

Cawley, John; Grabowski, David C.; Hirth, Richard A.

doi:10.1016/j.jhealeco.2005.06.004

Cited by 62 publications

(65 citation statements)

References 28 publications

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“…Clearly, certain aspects of quality are observable to patients and their families, while other aspects are unobservable, even with public report cards and regulatory oversight (Zhang and Grabowski 2004; Werner, Konetzka et al 2009). Aspects of post-acute nursing home quality that are unobservable to consumers include workforce quality (Cawley, Grabowski et al 2006) and various process and outcome measures unreported on government report card websites such as locomotion, bladder incontinence, and infections (Werner, Konetzka et al 2009). Given that nonprofit and government providers lack a defined shareholder, these firms may have less incentive to maximize profits and a greater incentive to maximize other objectives such as unobservable aspects of quality and the provision of public goods (Newhouse 1970; Hansmann 1980).…”

Section: Background and Related Researchmentioning

confidence: 99%

Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach

Grabowski

Feng

Hirth

et al. 2013

Journal of Health Economics

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130

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Given the preferential tax treatment afforded nonprofit firms, policymakers and researchers have been interested in whether the nonprofit sector provides higher nursing home quality relative to its for-profit counterpart. However, differential selection into for-profits and nonprofits can lead to biased estimates of the effect of ownership form. By using “differential distance” to the nearest nonprofit nursing home relative to the nearest for-profit nursing home, we mimic randomization of residents into more or less “exposure” to nonprofit homes when estimating the effects of ownership on quality of care. Using national Minimum Data Set assessments linked with Medicare claims, we use a national cohort of post-acute patients who were newly admitted to nursing homes within an 18-month period spanning January 1, 2004 and June 30, 2005. After instrumenting for ownership status, we found that post-acute patients in nonprofit facilities had fewer 30-day hospitalizations and greater improvement in mobility, pain, and functioning.

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Section: Background and Related Researchmentioning

confidence: 99%

Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach

Grabowski

Feng

Hirth

et al. 2013

Journal of Health Economics

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130

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“…Building from Cawley et al, (2006), we identify two plausible instruments for the wages of nursing home workers. The first is the effective real minimum wage rate present for each state-year.…”

Section: Treatment Of Nursing Home Residents With Dementia 281mentioning

confidence: 99%

Labor Prices and the Treatment of Nursing Home Residents with Dementia

Grabowski

Bowblis

Lucas

et al. 2011

International Journal of the Economics of Business

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An important aspect of dementia care for nursing home residents is the management of symptoms such as behavioral problems and wandering. Nursing homes can manage these symptoms using a mix of labor, medications and physical restraints. Medications such as antipsychotics are hypothesized to be a substitute for direct care staff, while physical restraints are considered to be a complement to staff time. Using an instrumental variables approach, we investigate whether an increase in nursing home wages leads to greater substitution towards antipsychotic medications and away from the use of physical restraints. Our results suggest a 10% increase in weekly nursing home wages increases the inappropriate use of antipsychotics among dementia patients by 1.1% to 3.5%, while it decreases the use of physical restraints by roughly 26% to 28%. These findings suggest policymakers should consider nursing home market factors when overseeing and regulating issues of nursing home quality.Factor Substitution, Nursing Homes, Long-Term Care,

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“…For instance, the insertion of catheters places the resident at greater risk for urinary tract infection (Cawley, Grabowski, and Hirth 2006;Park and Stearns 2009). Physical restraints, on the other hand, may increase the risk of bedsores, depression, mental and physical deterioration, and mortality (Park and Stearns 2009;Zinn 1993).…”

Section: Key Dependent and Explanatory Variablesmentioning

confidence: 99%

“…Following the nursing home literature, the county is used as a proxy for the geographic market (Cawley, Grabowski, and Hirth 2006). 18 Market-level variables used in this study include market concentration as measured by a Herfindahl-Hirschman Index using number of beds to measure market share, the log of population over the age of 65, and the log of per capita income.…”

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confidence: 99%

The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession

Antwi¹,

Bowblis²

2016

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in ABSTRACTWe estimate the causal effect of nurse turnover on mortality and the quality of nursing home care with a fixed effect instrumental variable estimation that uses the unemployment rate as an instrument for nursing turnover. We find that ignoring endogeneity leads to a systematic underestimation of the effect of nursing turnover on mortality and quality of care in a sample of California nursing homes. Specifically, 10 percentage point increase in nurse turnover results in a facility receiving 2.2 additional deficiencies per annual regulatory survey, reflecting a 19.3 percent increase. Not accounting for endogeneity of turnover leads to results that suggest only a 1 percent increase in deficiencies. We also find suggestive evidence that turnover results in lower quality in other dimensions and may increase mortality. An implication of our mortality results is that turnover may be a mechanism for the procyclicality of mortality rates. JEL Classification Codes: I11, J21, E24

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Factor substitution in nursing homes

Cited by 62 publications

References 28 publications

Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach

Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach

Labor Prices and the Treatment of Nursing Home Residents with Dementia

The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession

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