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.

项目总结/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， 养老院居民接受，他们的健康结果，和医护人员的结果。人员短缺是 养老院的财政资源有限，尤其是小型养老院， COVID-19疫情进一步加剧。这些人员短缺不成比例地影响护理 患有阿尔茨海默病和相关痴呆症（ADRD）的家庭居民，因为他们需要更多的时间从 工作人员相比，照顾居民谁没有ADRD。美国ADRD患者的数量 增加了对配备齐全的疗养院的需求，这些疗养院可以为患有ADRD的老年人提供优质护理 比以往任何时候都重要 在公共卫生紧急情况下，直接向养老院提供资金是一种权宜之计， 防止人员流失并保持居民的安全标准。一种联邦政策机制， 在2019冠状病毒病大流行期间，养老院的最佳做法是工资保障计划（PPP）。PPP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功效 直接资助小企业，在这个项目中，养老院，以保持安全的人员配备， 在公共卫生紧急情况下。虽然购买力平价贷款总体上有效地维持了工人的工资， 在美国所有的小企业中，目前还不清楚该计划的影响是否在养老院中是公平的 在社会经济贫困的社区，我们的团队之前的工作表明，这些社区的员工人数较少。 使用稳健的计量经济学方法和探索性的序贯混合方法， 项目将通过以下方式评估公私伙伴关系供资的有效性和公平性：1）检查人员配置模式的变化， 接受PPP贷款的养老院与未接受PPP贷款的养老院相比， 评估人员配置模式和结果的变化是否对生活在以下地区的ADRD患者公平 社会经济最贫困的设施; 2）定性探索设施战略，工具和社会 在获得购买力平价后，促进对人员配置和发展中国家恢复与重建驻地成果下降的适应能力的背景， 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居民的人员配备和护理的行政措施中，以及这些措施的不同之处 邻里背景。总体目标是制定一个框架，以指导未来的养老院 应对突发公共卫生事件，将改善工作人员模式， 社会经济最贫困/资源最少的社区。