Table 4.
Stage Two Analysis and Ordinary Least Square Analysis: RN Hours and Total Nursing Hours (Coefficients with Robust Standard Errors in Parentheses)
| RN Nursing Hours OLS Regression | RN Nursing Hours 2SLS† | Total Nursing Hours OLS Regression | Total Nursing Hours 2SLS† | |
|---|---|---|---|---|
| Potentially endogenous variables | ||||
| State Medicaid reimbursement rate | 0.002** | 0.001* | 0.006** | 0.010** |
| (0.0003) | (0.001) | (0.001) | (0.001) | |
| Resident case mix (ADL dependency) | 0.020* | 0.392** | 0.175** | −0.821** |
| (0.008) | (0.107) | (0.015) | (0.233) | |
| Exogenous variables | ||||
| Facility resources | ||||
| RN pay rate per hour | −0.014** | −0.029** | 0.006 | 0.028 |
| (0.004) | (0.007) | (0.008) | (0.016) | |
| Proportion Medicaid residents | −0.003** | −0.003** | −0.005** | −0.006** |
| (0.0002) | (0.0002) | (0.0004) | (0.001) | |
| Medicaid case-mix reimbursement | 0.002 | 0.008 | −0.163** | −0.177** |
| (0.011) | (0.012) | (0.021) | (0.026) | |
| Medicaid prospective reimbursement method | ||||
| State RN staffing standard | 0.169** | 0.166** | 0.479** | 0.388** |
| (0.032) | (0.040) | (0.062) | (0.083) | |
| Medicare SNF reimbursement rate | 0.002** | 0.004** | −0.002** | −0.007** |
| (0.0003) | (0.001) | (0.001) | (0.002) | |
| Facility characteristics | ||||
| For-profit facility | −0.143** | −0.118** | −0.343** | −0.376** |
| (0.009) | (0.012) | (0.018) | (0.024) | |
| Multifacility system member | −0.005 | −0.004 | −0.124** | −0.119** |
| (0.008) | (0.009) | (0.016) | (0.019) | |
| Hospital-based | 0.023 | 0.019 | 0.056 | 0.059 |
| (0.016) | (0.017) | (0.030) | (0.036) | |
| Number of facility beds | −0.001** | −0.001** | −0.001** | −0.001** |
| (0.0001) | (0.0001) | (0.0001) | (0.0002) | |
| Dual/distinct part certification | 0.089** | −0.008 | 0.158** | 0.381** |
| (0.010) | (0.031) | (0.022) | (0.065) | |
| SNF certification | 1.935** | 1.966** | 2.926** | 2.817** |
| (0.059) | (0.063) | (0.101) | (0.112) | |
| County demographic/economic variables demographic/economic variables | ||||
| Proportion aged 65 and older | 0.001 | 0.013* | 0.006 | −0.035** |
| (0.003) | (0.005) | (0.006) | (0.011) | |
| Percentage females in labor force | 0.001 | 0.006** | 0.002 | −0.014** |
| (0.002) | (0.002) | (0.003) | (0.005) | |
| Personal income per capita | 0.014** | 0.016** | −0.012** | 0.024** |
| (0.002) | (0.003) | (0.004) | (0.006) | |
| Percent metropolitan population | −0.003** | −0.004** | −0.002* | 0.001 |
| (0.001) | (0.001) | (0.001) | (0.001) | |
| Political variables | ||||
| Democratic governor | ||||
| Political party split | 0.042** | 0.106** | 0.071** | −0.053 |
| (0.011) | (0.023) | (0.021) | (0.047) | |
| Market factors | ||||
| NF Herfindahl index (facility concentration) | −0.042** | 0.007 | −0.038 | −0.144** |
| (0.015) | (0.023) | (0.032) | (0.048) | |
| Percent excess NF beds in the county | 0.001 | 0.002** | 0.008** | 0.005** |
| (0.001) | (0.001) | (0.001) | (0.002) | |
| Nursing home beds per 1,000 aged 65+ | −0.002** | 0.002 | −0.011** | −0.022** |
| (0.0004) | (0.001) | (0.001) | (0.003) | |
| Hospital beds per 1,000 population | 0.001 | 0.002 | 0.008** | 0.007* |
| (0.001) | (0.002) | (0.003) | (0.003) | |
| Intercept | 0.195 | −2.88** | 3.355** | 11.700** |
| (0.125) | (0.892) | (0.235) | (1.984) | |
| R2 | 0.560** | 0.443** | 0.486** | 0.229** |
| Mean= | 0.66 | 0.66 | 3.62 | 3.62 |
| N =14,256; df = | 22 | 22 | 22 | 22 |
*
Significant at the .05 level.
**
Significant at the .01 level.
†
Because reimbursement rates and ADL were endogenous, the 2SLS model was the most appropriate.
The shaded areas show instrumental variables that predict endogenous variables but that do not predict RN hours and total nursing hours.
RN, registered nurse; SNF, skilled nursing care; NF, nursing facility; OLS, ordinary least squares; 2SLS, two-stage least square; ADL, activities of daily living.