Evaluating the Effect of National Background Check Program on Nursing Home Deficiency Citations

To evaluate the impact of the National Background Check Program (NBCP) on nursing home (NH) health deficiencies and citations related to abuse, neglect, and exploitation.

This study uses the Callaway and Sant'Anna Difference-in-Differences (CSDID) quasi-experimental method to analyze data from US nursing homes from 2009 to 2016. The study includes nursing homes from 18 states that received NBCP grants as treatment group and nursing homes from 24 states that did not receive NBCP grants as control group. We exclude eight pilot NBCP states.

We used facility-level deficiency data from NH Care Compare (CC), NH characteristics data from Certification and Survey Provider Enhanced Reports (CASPER), and Alzheimer's Disease and Related Dementias diagnosis data from Minimum Data Set (MDS) assessments, covering 96,261 nursing home-year observations.

Overall, NBCP implementation was associated with a significant reduction in health deficiencies (-0.760, p < 0.01) and a decrease in the probability and number of citations for abuse, neglect, and exploitation (-0.029, p < 0.01; -0.048, p < 0.01). Subgroup analyses showed that NBCP was associated with reductions in health deficiencies in nursing homes, regardless of whether they had a high or low census of residents with Alzheimer's Disease and Related Dementias, and in both metropolitan and nonmetropolitan areas. However, the effects varied across states depending on when they adopted NBCP.

Our findings suggest that NBCP is an effective regulatory tool for improving nursing home deficiencies and reducing incidents of abuse-related violations. We need more research to assess if background check programs improve nursing home quality using resident-level outcomes.