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J Gerontol B Psychol Sci Soc Sci. 2009 Mar;64(2):269-78. doi: 10.1093/geronb/gbn019. Epub 2009 Jan 29.

A panel data analysis of the relationships of nursing home staffing levels and standards to regulatory deficiencies.

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  • 1New York University College of Nursing, 246 Greene Street, Room 602 West, New York, NY 10003, USA.



To examine the relationships between nursing staffing levels and nursing home deficiencies.


This panel data analysis employed random-effect models that adjusted for unobserved, nursing home-specific heterogeneity over time. Data were obtained from California's long-term care annual cost report data and the Automated Certification and Licensing Administrative Information and Management Systems data from 1999 to 2003, linked with other secondary data sources.


Both total nursing staffing and registered nurse (RN) staffing levels were negatively related to total deficiencies, quality of care deficiencies, and serious deficiencies that may cause harm or jeopardy to nursing home residents. Nursing homes that met the state staffing standard received fewer total deficiencies and quality of care deficiencies than nursing homes that failed to meet the standard. Meeting the state staffing standard was not related to receiving serious deficiencies.


Total nursing staffing and RN staffing levels were predictors of nursing home quality. Further research is needed on the effectiveness of state minimum staffing standards.

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