The effects of California minimum nurse staffing laws on nurse labor and patient mortality in skilled nursing facilities

Abstract

This article investigates how a change in minimum nurse staffing regulation for California skilled nursing facilities (SNFs) affects nurse employment and how induced changes in nurse staffing affect patient mortality. In 2000, legislation increased the minimum nurse staffing standard and altered the calculation of nurse staffing, which created incentives to shift employment to lower skilled nurse labor. SNFs constrained by the new regulation increase absolute and relative hours worked by the lowest skilled type of nurse. Using this regulation change to instrument for measured nurse staffing levels, it is determined that increases in nurse staffing reduce on-site SNF patient mortality.

The Best of Times, the Worst of Times: Understanding Pro-cyclical Mortality

“…In order to gauge this, we combine our findings with estimates from the literature on the relationship between nursing home staffing and residential outcomes produced by two quasi-experimental studies. Tong (2011) uses a regulatory change in California to examine the relationship between nursing staff and nursing home mortality, and finds that the increase in certified nurse assistants (CNAs) that resulted from the new staffing regulation was 0.26 hours per resident-day (compared to a baseline level of 1.987 hours per resident-day), and that this was accompanied by a decrease in patient mortality of 4.6 percent. If we interpret this reduction in mortality as coming solely through the CNA channel, this implies an elasticity of −0.35.…”

Predictors of emergency commitment for nursing home residents: the role of resident and facility characteristics

“…Study findings did not show an association between nurse staffing ratio and EC, which is consistent with the recent findings of Hyer and colleagues () showing no association between licensed nurse staffing ratios and the quality of care. However, other research studies have suggested a positive relationship between nurse staffing ratios and quality of care outcomes (Bowblis, ; Tong, ). Additional research is needed to better understand the complex relationship between nurse staffing ratios and EC.…”

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

“…Prior to 2000, total nursing staff hours were defined as CNA hours plus two times the sum of RN and LPN hours. Studies have found that low staffing nursing homes increased total nurse staffing mainly by increasing CNA labor [60,197]. On the other hand, nursing homes may be affected by the existing evidence that more skilled nurse staffing may be more important than CNA in quality improvement.…”