The Paycheck Protection Program and its Effects on Staffing Patterns and the Outcomes of Residents Living with Dementia

薪资保护计划及其对人员配置模式和痴呆症居民结局的影响

• 批准号: 10729652
• 负责人: Jason Raymond Falvey
• 金额: $ 74.02万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729652
• 关键词: Address; Alzheimer' s disease related dementia; American; Area; Behavior; Businesses; COVID-19; COVID-19 pandemic; Caring; Characteristics; Clinical; Data; Dementia; Development; Diagnosis; Disasters; Disparity population; Economic Factors; Economics; Effectiveness; Elderly; Eligibility Determination; Emergency Situation; Equity; Event; Excess Mortality; Funding; Future; Goals; Health; Health Personnel; Health Services Research; Health care facility; Home Nursing Care; Hour; Individual; Infrastructure; Intervention; Interview; Leadership; Medicare; Methods; Natural experiment; Neighborhoods; Nurse Administrator; Nursing Homes; Nursing Staff; Outcome; Pattern; Phase; Policies; Population; Preparation; Public Health; Qualitative Research; Quality of Care; Reporting; Resources; Safety; Shock; Social Environment; Structure; Survey Methodology; Surveys; Time; Work; cohort; community-level factor; deprivation; design; econometrics; economic disparity; effectiveness evaluation; experience; federal policy; health disparity; improved; improved outcome; indexing; mortality; nursing care quality; pandemic disease; prevent; programs; promote resilience; public health emergency; resilience; resilience factor; response; socioeconomics; telehealth; tool; ventilation

PROJECT SUMMARY/ABSTRACT . Nursing home staff shortages are well known to be an important factor impacting both the quality of care that nursing home residents receive, their health outcomes, and healthcare worker outcomes. Staffing shortages are compounded by limited financial resources in nursing homes, especially for smaller nursing homes, which was further exacerbated by the COVID-19 pandemic. These staffing shortages disproportionately impact nursing home residents living with Alzheimer’s disease and related dementias (ADRD) as they require more time from staff compared to care for residents who do not have ADRD. As the number of Americans living with ADRD increases, the need for fully staffed nursing homes that can provide quality care for older adults living with ADRD is now more important than ever. During public health emergencies, direct funding to nursing homes has been proposed as an expedient way to prevent staffing losses and maintain safety standards for residents. One federal policy mechanism utilized by nursing homes during the COVID-19 pandemic was the Paycheck Protection Program (PPP). The PPP loan program offers a unique natural experiment by which to evaluate the effectiveness and efficacy of a program that directly funds small businesses and in the case of this project, nursing homes, to maintain safe staffing levels during public health emergencies. While PPP loans were effective overall at keeping workers on the payroll across all US small businesses, it is unclear if the effects of the program were equitable across nursing homes in socioeconomically deprived neighborhoods which prior work from our team showed have lower staffing rates. Using robust econometric methods and an exploratory sequential mixed methods approach, the proposed project will assess the effectiveness and equity of PPP funding by 1) examining changes in staffing patterns and resident outcomes among nursing homes that received the PPP loans compared to nursing homes that did not and evaluating whether changes in staffing patterns and outcomes were equitable for those with ADRD living in the most socioeconomically deprived facilities; 2) qualitatively exploring facility strategies, tools, and social contexts that promoted resilience to declines in staffing and ADRD resident outcomes after receipt of PPP, and 3) quantitatively assessing the extent to which resilience strategies, cultures, and behaviors identified in Aim 2 are reflected in administrative actions about staffing and care for residents with ADRD, and how actions differed by neighborhood context. The overall goal is to develop a framework by which to guide future nursing home responses to public health emergencies that will improve staff patterns and subsequent ADRD outcomes in the most socioeconomically deprived/lowest-resourced neighborhoods.

项目摘要/摘要 。 众所周知，养老院工作人员短缺是影响护理质量的一个重要因素， 疗养院居民的收入、他们的健康结果和医护人员的结果。人员短缺是 疗养院的财政资源有限，特别是较小的疗养院，这使情况变得更加复杂 新冠肺炎大流行进一步加剧了这一趋势。这些人员短缺对护理造成了不成比例的影响 患有阿尔茨海默病和相关痴呆(ADRD)的家庭居民，因为他们需要更多的时间 将工作人员与护理没有ADRD的居民进行比较。因为患有ADRD的美国人的数量 增加，需要配备齐全的疗养院，为患有ADRD的老年人提供高质量的护理 现在比以往任何时候都更加重要。 在突发公共卫生事件期间，建议直接资助养老院作为一种权宜之计 防止人员流失，维护居民的安全标准。一个联邦政策机制由 新冠肺炎大流行期间的养老院是支付宝保护计划(PPP)。购买力平价贷款 计划提供了一个独特的自然实验，通过它来评估计划的有效性和有效性 直接资助小企业，在这个项目中，疗养院，以维持安全的人员配备 在突发公共卫生事件期间的水平。虽然购买力平价贷款总体上有效地让工人留在工资单上 在所有美国小企业中，尚不清楚该计划对养老院的影响是否公平 我们团队之前的工作表明，在社会经济贫困的社区，人员配备比例较低。 利用稳健的计量经济学方法和探索性的顺序混合方法，建议的 该项目将通过1)审查人员配置模式的变化和 获得购买力平价贷款的养老院与没有获得购买力平价贷款的养老院的住院结果比较 以及评估人员配置模式和结果的变化是否对居住在 最缺乏社会经济条件的设施；2)定性地探索设施战略、工具和社会 在收到购买力平价后，促进对人员编制和ADRD驻地成果下降的复原力的背景，以及 3)定量评估目标2中确定的弹性策略、文化和行为的程度 反映在有关ADRD患者的人员配备和护理的行政行动中，以及这些行动有何不同 根据附近的环境。总体目标是开发一个框架，用以指导未来的疗养院 对突发公共卫生事件的应对将改善工作人员模式和随后的ADRD成果 大多数社会经济贫困/资源最贫乏的社区。