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.

项目概要/摘要 。 众所周知，疗养院工作人员短缺是影响护理质量的一个重要因素。 疗养院居民的接受情况、他们的健康状况以及医护人员的状况都是如此。 疗养院的财政资源有限，尤其是小型疗养院， COVID-19 大流行进一步加剧了这些人员短缺对护理的影响。 患有阿尔茨海默病和相关痴呆症 (ADRD) 的家庭居民，因为他们需要更多时间 与照顾没有 ADRD 的居民相比，患有 ADRD 的美国人的数量。 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 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，有人建议向疗养院直接提供资金，作为一种权宜之计 防止人员流失并维持居民的安全标准。 一种联邦政策机制。 COVID-19 大流行期间的疗养院是薪资保护计划 (PPP)。 计划提供了一个独特的自然实验来评估计划的有效性和功效 直接资助小型企业，就本项目而言，为疗养院提供资金，以维持安全的人员配置 公共卫生紧急情况期间的水平，而 PPP 贷款总体上有效地保持了工人的工资。 对于所有美国小型企业，目前尚不清楚该计划的影响在疗养院中是否公平 我们团队之前的工作表明，在社会经济贫困的社区，人员配备率较低。 使用稳健的计量经济学方法和探索性序贯混合方法，提出了 项目将通过以下方式评估 PPP 融资的有效性和公平性： 1) 检查人员配置模式的变化和 接受 PPP 贷款的疗养院与未获得 PPP 贷款的疗养院的居民结果相比 评估人员配置模式和结果的变化对于居住在该地区的 ADRD 患者是否公平 2）定性探索设施策略、工具和社会 收到 PPP 后，对人员配置下降和 ADRD 居民结果的恢复能力得到提升，以及 3) 定量评估目标 2 中确定的复原力策略、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行动中，以及行动有何不同 总体目标是制定一个框架来指导未来的疗养院。 应对公共卫生紧急情况，这将改善人员模式和随后的 ADRD 结果 社会经济最贫困/资源最匮乏的社区。