Association of Receipt of Paycheck Protection Program Loans With Staffing Patterns Among US Nursing Homes.
Association of Receipt of Paycheck Protection Program Loans With Staffing Patterns Among US Nursing Homes.
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DOI：
10.1001/jamanetworkopen.2023.26122
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发表时间：
2023-07-03
影响因子：
13.8
通讯作者：
中科院分区：
文献类型：
--
作者：
这项经济评估评估了Paycheck保护计划贷款收据和养老院工作人员工作时间之间的关系。通过Paycheck Protection Program(PPP)获得可免除贷款的养老院的人员配备时间有变化吗？Paycheck Protection Program(PPP)要求接受者将贷款的60%至75%用于人员配备？在这项对6008家美国养老院进行的经济分析中，在收到PPP贷款12周后，与没有获得PPP贷款的养老院相比，获得PPP贷款的养老院每周注册护士助理小时数和持证实习护士小时数都有所增加。未发现购买力平价贷款收据与注册护士每周工作时间之间的关联。研究结果表明，专门的人员配备资金计划可能与疗养院工作时间的增加有关。疗养院的人员短缺威胁到居民护理的质量，而新冠肺炎疫情放大了疗养院内部严重的人员短缺。在大流行期间，美国国会颁布了Paycheck Protection Program(PPP)，这是一项可免除贷款计划，要求符合条件的接受者将贷款的60%至75%用于人员编制，才有资格获得贷款减免。为了评估PPP贷款接受者NHS与非贷款接受者NHS的特征，以及与没有获得贷款的NHS相比，NHS在获得贷款的人员工作时间方面是否发生了变化。这项经济评估使用了从小企业管理局、疗养院比较、LTCFocus、医疗保险和医疗补助服务中心基于工资的杂志、最低数据集、区域剥夺指数、医疗保健成本报告信息系统和美国农业部农村-城市连续代码收集的2020年1月1日至12月23日关于美国养老院的全国数据。薪资保护计划贷款收据状态。人员配置变量包括注册护士、执业护士(LPN)和注册护士助理(CNA)每周总时数。在研究期间，每周在收到贷款之前和之后检查工作人员的工作时间。采用事件研究法，与没有获得购买力平价贷款的NHS相比，估算了NHS获得PPP贷款的每周工作总时数。在6008个美国NHS中，1807个(30.1%)获得了PPP贷款，4201个(69.9%)没有获得PPP贷款。贷款金额中值为664 349(IQR，407 000-1 058 300)。贷款接受者不太可能是产业链的一部分(733[40.6%]比2592[61.7%])，更有可能是营利性的(1342[74.3%]比2877[68.5%])，位于非城市环境(159[8.8%]比183[4.4%])，有更多的比例由医疗补助资助的居民(平均[SD]，60.92%[21.58%]比56.78%[25.57%])，并且员工质量评级较低(平均[SD])，2.88[1.20]vs 3.03[1.22])和整体质量星级(平均值[SD]，3.08[1.44]vs 3.22[1.44])(P <；均为 .001)。在获得PPP贷款12周后，与没有获得PPP贷款的养老院相比，获得PPP贷款的NHS经历了平均每周26.19个CNA小时(95%CI，每周14.50-37.87小时)和平均6.67个LPN小时(95%CI，每周1.21-12.12小时)的差异。未发现购买力平价贷款收入与每周RN工作时间之间的关联(12周：平均差异，每周1.99小时；95%CI，−每周2.38至6.36小时)。在这项经济评估中，要求拨款用于人员配备的可免除贷款计划与NH PPP贷款接受者的CNA和LPN工作时间显著增加有关。由于购买力平价贷款是临时性的，联邦和州实体可能需要提供足够和可持续的支持，以缓解NH人员短缺。
This economic evaluation assesses the association between Paycheck Protection Program loan receipt and nursing home staffing hours. Did staffing hours change among nursing homes that received forgivable loans through the Paycheck Protection Program (PPP), which required recipients to appropriate 60% to 75% of the loan toward staffing? In this economic analysis of 6008 US nursing homes, 12 weeks after PPP loan receipt, nursing homes that received a PPP loan experienced increases in certified nursing assistant hours per week and licensed practical nurse hours per week compared with nursing homes that did not receive a PPP loan. No association was found between PPP loan receipt and registered nurse staffing hours per week. The findings suggest that dedicated funding programs for staffing may be associated with increased nursing home staffing hours. Staffing shortages in nursing homes (NHs) threaten the quality of resident care, and the COVID-19 pandemic magnified critical staffing shortages within NHs. During the pandemic, the US Congress enacted the Paycheck Protection Program (PPP), a forgivable loan program that required eligible recipients to appropriate 60% to 75% of the loan toward staffing to qualify for loan forgiveness. To evaluate characteristics of PPP loan recipient NHs vs nonloan recipient NHs and whether there were changes in staffing hours at NHs that received a loan compared with those that did not. This economic evaluation used national data on US nursing homes that were aggregated from the Small Business Administration, Nursing Home Compare, LTCFocus, the Centers for Medicare & Medicaid Services Payroll Based Journal, the Minimum Data Set, the Area Deprivation Index, the Healthcare Cost Report Information System, and the US Department of Agriculture Rural-Urban Continuum Codes from January 1 to December 23, 2020. Paycheck Protection Program loan receipt status. Staffing variables included registered nurse, licensed practical nurse (LPN), and certified nursing assistant (CNA) total hours per week. Staffing hours were examined on a weekly basis before and after loan receipt during the study period. An event-study approach was used to estimate the staffing total weekly hours at NHs that received PPP loans compared with NHs that did not receive a PPP loan. Among 6008 US NHs, 1807 (30.1%) received a PPP loan and 4201 (69.9%) did not. The median loan amount was $664 349 (IQR, $407 000-$1 058 300). Loan recipients were less likely to be part of a chain (733 [40.6%] vs 2592 [61.7%]) and more likely to be for profit (1342 [74.3%] vs 2877 [68.5%]), be located in nonurban settings (159 [8.8%] vs 183 [4.4%]), have a greater proportion of Medicaid-funded residents (mean [SD], 60.92% [21.58%] vs 56.78% [25.57%]), and have lower staffing quality ratings (mean [SD], 2.88 [1.20] vs 3.03 [1.22]) and overall quality star ratings (mean [SD], 3.08 [1.44] vs 3.22 [1.44]) (P < .001 for all). Twelve weeks after PPP loan receipt, NHs that received a PPP loan experienced a mean difference of 26.19 more CNA hours per week (95% CI, 14.50-37.87 hours per week) and a mean difference of 6.67 more LPN hours per week (95% CI, 1.21-12.12 hours per week) compared with nursing homes that did not receive a PPP loan. No associations were found between PPP loan receipt and weekly RN staffing hours (12 weeks: mean difference, 1.99 hours per week; 95% CI, −2.38 to 6.36 hours per week). In this economic evaluation, a forgivable loan program that required funding to be appropriated toward staffing was associated with a significant increase in CNA and LPN staffing hours among NH PPP loan recipients. Because the PPP loans are temporary, federal and state entities may need to institute sufficient and sustainable support to mitigate NH staffing shortages.
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影响因子：
5.7
作者：
Chen K;Lopez L 3rd;Ross JS;Travers JL
通讯作者：
Travers JL
DOI：
10.1377/hlthaff.2020.01269
发表时间：
2020-10
期刊：
Health affairs (Project Hope)
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通讯作者：
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作者：
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