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Addressing Staffing Shortages in Nursing Homes: Does Relaxing Training and Licensing Requirements Increase Nurse Aide
Gulrukh Mehboob1, Hari Sharma1
1Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, Iowa, USA.
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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