Do Minimum Quality Standards Improve Quality? A Case Study of the Nursing Home Industry

This article estimates the impact of minimum staffing requirements on the nursing home market using a unique national panel over the 1996-2005 period. This study reveals that, given a half-hour increase in the minimum nursing hours per resident day for licensed nurses, quality of patient care increases by 25 percent. This quality-increasing effect is mainly driven by low-quality nursing homes increasing their quality of care to meet the new standards. By contrast, minimum staffing requirements for direct-care nurses do not have any significant impact on quality. This lack of impact may be explained by nursing home providers circumventing this regulation by hiring less expensive and less skilled laborers as substitutes for direct-care nurses.