Why Nursing-Home Staffing Is Crucial to Health

Study finds that resident death rates increase when caregiving staff levels are reduced.

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Loss of caregiving help is literally deadly for older folks, according to a study from the Center for Retirement Research at Boston College. Perhaps surprisingly, death rates actually rise when the economy is stronger. In researching why this happens, the Center found that when employment rises, nursing homes lose staffers who prefer other jobs. This loss of caregiving, in turn, is associated with higher death rates, particularly for older women, who tend to outlive men and thus are more likely to need old-age care.

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The outlook for nursing homes and caregiving resources in general is sobering. It's a certainty that rising numbers of aging Americans will need more care in the future. People in their 80s are the nation's fastest-growing age group. Over this same period, the retiring baby-boom generation will be succeeded in the workforce by much smaller generations of younger workers. The result will be a growing shortage of care providers.

Moreover, government reimbursement rates for some nursing-home services have been cut by Medicare and the industry is under growing financial pressure. Prospects are high for continued curbs on healthcare spending. Accordingly, operators of the nation's roughly 1.6 million certified nursing beds are looking for efficiencies and ways to streamline services, not add to staffing levels.

The traditional thinking about why death rates increase during strong economies was tied to job-related stress and behavior, the Center for Retirement Research study said. "During boom times, when more people are employed, job-related stress may increase obesity and smoking," it said. "High employment and long hours on the job also limit individuals' ability to find time for diet and exercise, causing health to deteriorate."

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The study's four authors, all from the University of California-Davis, looked at the age groups that had the biggest mortality increase tied to rising employment levels. Here, they found that nearly all of the impact was on people over age 65, and predominantly older women. They looked at deaths in 2006, a year in which the unemployment rate dropped by 1.1 percentage points, and determined that employment gains were associated with 6,700 additional deaths that year.

"Working-age men and women accounted for just 9 percent of the 6,700 additional deaths in 2006," the study said. "Instead, the elderly dominated here: Deaths among people ages 65 and older accounted for 75 percent of the 6,700 additional deaths ... Notably, women over 65 alone accounted for 55 percent of the additional deaths."

Because older people are often no longer working, tying their health to their own employment changes didn't make sense. But when the researchers looked more deeply into the higher rate of deaths among older people, they wondered if it might be tied to employment changes in health facilities.

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What they found was that employment levels in healthcare actually dropped amidst overall gains in employment. "Low-paid, low-skill health workers find better jobs elsewhere," the study said, and they are not fully replaced.

Digging deeper, they found the employment-mortality effect was significant in only one type of healthcare facility: nursing homes. Because nursing homes contain far more women than men, this finding also explained why older women were more adversely affected than older men. "The analysis revealed that a 1-percentage point decline in the unemployment rate caused more than a 3-percent drop in overall full-time employment at nursing homes," the study said.

When the researchers looked at state-by-state death rates, they also found higher numbers of deaths among older people in states with larger nursing-home populations.

"A greater scarcity of these front-line caregivers may have a direct impact on the elderly," the study concluded, "causing them to die in greater numbers when the unemployment rate is declining."