Journal article
Addressing Staffing Shortages in Nursing Homes: Does Relaxing Training and Licensing Requirements Increase Nurse Aide Staffing?
Health services research, Vol.60(3), e14455
06/2025
DOI: 10.1111/1475-6773.14455
PMCID: PMC12120521
PMID: 39972516
Appears in UI Libraries Support Open Access
Abstract
To evaluate whether COVID-19-related nurse aide training and licensing relaxation policies improved staffing shortages in nursing homes.
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.
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.
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.
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.
Details
- Title: Subtitle
- Addressing Staffing Shortages in Nursing Homes: Does Relaxing Training and Licensing Requirements Increase Nurse Aide Staffing?
- Creators
- Gulrukh Mehboob - University of IowaHari Sharma - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Health services research, Vol.60(3), e14455
- DOI
- 10.1111/1475-6773.14455
- PMID
- 39972516
- PMCID
- PMC12120521
- NLM abbreviation
- Health Serv Res
- ISSN
- 1475-6773
- eISSN
- 1475-6773
- Publisher
- Wiley
- Language
- English
- Electronic publication date
- 02/19/2025
- Date published
- 06/2025
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984792367602771
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