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

35 Pages Posted: 21 May 2015 Last revised: 12 Nov 2015

See all articles by Yaa Akosa Antwi

Yaa Akosa Antwi

Johns Hopkins University - Carey Business School

John R. Bowblis

Miami University of Ohio - Department of Economics

Multiple version iconThere are 2 versions of this paper

Date Written: November 11, 2015

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 pro-cyclicality of mortality rates.

Keywords: Nursing Home, Quality, Turnover, Instrumental Variables

Suggested Citation

Akosa Antwi, Yaa and Bowblis, John R., The Impact of Nurse Turnover on Quality of Care and Mortality in Nursing Homes: Evidence from the Great Recession (November 11, 2015). Available at SSRN: https://ssrn.com/abstract=2608247 or http://dx.doi.org/10.2139/ssrn.2608247

Yaa Akosa Antwi (Contact Author)

Johns Hopkins University - Carey Business School ( email )

100 International Drive
Baltimore, MD 21202
United States

John R. Bowblis

Miami University of Ohio - Department of Economics ( email )

800 E. High St.
Farmer School of Business, 2054
Oxford, OH 45056
United States

Here is the Coronavirus
related research on SSRN

Paper statistics

Downloads
83
Abstract Views
982
rank
175,984
PlumX Metrics