Research Activities, August 2013

Quality regulation of nursing homes leads to better care quality, at least in some areas

Elderly Health/Long-Term Care

Both Federal and State governments set minimum quality and safety standards for nursing homes. A new study concludes that more stringent State regulation leads to better quality for four of seven measures of nursing home quality: certified nursing assistant (CNA) staffing, licensed practical nurse (LPN) staffing, risk-adjusted urinary incontinence, and decline in residents' activities of daily living (ADL). Greater regulatory stringency did not affect either high-risk pressure sores or hotel expenditures (linens, laundry, housekeeping, and maintenance), and had a negative impact on registered nurse (RN) staffing by leading to fewer RNs. 

This latter finding might be due to nursing homes substituting expensive RN labor with less expensive LPNs or CNAs, note the researchers. The stringency of regulation was measured by the HRSI, an index based on the number and percentage of deficiencies per facility, the percent of facilities with any deficiency or substandard care, and the average number of State and Federal civil monetary penalties per facility.

The study included all 16,352 Medicare and Medicaid certified nursing homes and all of their residents during 2005 and 2006. After considering other factors influencing quality of care, and using instrumental variables techniques to account for the endogeneity of regulation and quality, the researchers found that more stringent regulations improve quality at least in some dimensions. Based on their cost-effectiveness estimates, they suggest that increasing the stringency of regulation is an effective policy tool for improving quality in nursing homes. 

See "The effect of State regulatory stringency on nursing home quality" by Dana B. Mukamel, Ph.D., David L. Weimer, Ph.D., Charlene Harrington, Ph.D., and others in the October 2012 HSR: Health Services Research 47(5), pp. 1791-1813. Reprints (AHRQ Publication No. 13-R028) are available from AHRQ.


Page last reviewed August 2013
Page originally created August 2013
Internet Citation: Quality regulation of nursing homes leads to better care quality, at least in some areas. Content last reviewed August 2013. Agency for Healthcare Research and Quality, Rockville, MD.