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

Upjohn Institute Working Paper No. 16-249

41 Pages Posted: 14 Jan 2016

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: January 13, 2016

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.

Keywords: Employee turnover, unemployment rate, quality of care, nursing home

JEL Classification: I11, J21, E24

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 (January 13, 2016). Upjohn Institute Working Paper No. 16-249. Available at SSRN: https://ssrn.com/abstract=2714962 or http://dx.doi.org/10.2139/ssrn.2714962

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

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