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The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession

Author

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  • Yaa Akosa Antwi

    (Indiana University - Purdue University Indianapolis)

  • John R. Bowblis

    (Miami University)

Abstract

We estimate the causal effect of nurse turnover on mortality and the quality of nursing home care with a fixed effect instrumental variable estimation that uses the unemployment rate as an instrument for nursing turnover. We find that ignoring endogeneity leads to a systematic underestimation of the effect of nursing turnover on mortality and quality of care in a sample of California nursing homes. Specifically, 10 percentage point increase in nurse turnover results in a facility receiving 2.2 additional deficiencies per annual regulatory survey, reflecting a 19.3 percent increase. Not accounting for endogeneity of turnover leads to results that suggest only a 1 percent increase in deficiencies. We also find suggestive evidence that turnover results in lower quality in other dimensions and may increase mortality. An implication of our mortality results is that turnover may be a mechanism for the procyclicality of mortality rates.

Suggested Citation

  • Yaa Akosa Antwi & John R. Bowblis, 2016. "The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession," Upjohn Working Papers and Journal Articles 16-249, W.E. Upjohn Institute for Employment Research.
  • Handle: RePEc:upj:weupjo:16-249
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    References listed on IDEAS

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    Cited by:

    1. R. Tamara Konetzka & Karen B. Lasater & Edward C. Norton & Rachel M. Werner, 2017. "Are Recessions Good for Staffing in Nursing Homes?," NBER Working Papers 23402, National Bureau of Economic Research, Inc.

    More about this item

    Keywords

    Employee turnover; unemployment rate; quality of care; nursing home;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • J21 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Labor Force and Employment, Size, and Structure
    • E24 - Macroeconomics and Monetary Economics - - Consumption, Saving, Production, Employment, and Investment - - - Employment; Unemployment; Wages; Intergenerational Income Distribution; Aggregate Human Capital; Aggregate Labor Productivity

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