A study conducted by Georgetown University Medical Center (GUMC) and published to the Gerontologist found that nursing homes see improvement in care quality and employee retention during periods of economic recession and worsens when the economy is good. This is among one of the first known studies to examine how fluctuations in business cycles (economic expansions and recessions) play a role in nursing home staffing patterns and the care that is provided.
Data from 2001 through 2015 were drawn from data sources like state annual recertification of all Medicare and Medicaid certified nursing homes (about 15,000 nursing homes) and county-level unemployment rates from the Bureau of Labor Statistics. Within this set of data is two economic expansions and contractions. Statistical models were estimated to determine the effect the unemployment rate had on nursing home quality and staffing outcomes.
Researchers found that higher unemployment rates are associated with a statistically significant improvement in care quality. During this time, nursing homes became more compliant with health regulations and nursing home residents, on average, were less likely to have pressure ulcers, be physically restrained, or have significant weight loss (all measures of care quality).
Low unemployment rates have result in lower nursing staff levels, higher employee turnover and poor retention rates. Most care in nursing homes is provided by nurses and nurses aides. Having a stable or unstable staff contributes to the quality of care, researchers say. For example, high turnover of staff deprives nursing home patients of receiving consistent care from the same nurses, a practice that is associated with quality care.
“During economic downturns, many people are willing to take positions with work environments they may not prefer because there aren’t many options. But when the economy is good, there are plenty of employment opportunities and taking a nursing home job may not be that attractive,” says the study’s principal investigator, Sean Shenghsiu Huang, PhD, assistant professor in the Department of Health Systems Administration at GUMC’s School of Nursing & Health Studies.
Nursing home care is highly labor intensive and mainly delivered by nurses and nurse aides. Because most nursing home residents have cognitive dysfunction or physical impairment, they require around the clock care. Providing this long-term and laborious care can be physically and mentally demanding making it difficult for nursing homes to hire and retain staff.
“It is clear from our data that as unemployment rates increased, nursing home quality was higher as fewer residents would develop pressure ulcers, be restrained, and experience weight loss,” Huang says. “This is likely due to nursing home staff. Higher unemployment rates are linked to higher nursing staff levels. In these recessions, nursing homes were better able to retain their staff and reduce turnover.”
Given today’s low unemployment rates, it will be challenging to maintain or even attempt to lower the turnover rates, say the investigators.