The Unintended Consequences of Staffing Mandates in Florida Nursing Homes: Impacts on Indirect-Care Staff

Academic Article


  • Research on nursing staff ratios and quality of care in nursing homes prompted Florida to implement minimum nursing staff ratios for certified nursing assistants (CNAs) in 2001. Using the contingency theory, the authors investigated the response to this mandate and its potential effects on indirect-care staff. This study used the Online Survey, Certification, and Reporting (OSCAR) staffing data for freestanding Florida nursing homes between the years 1999 and 2004. Piecewise regression growth curve models were investigated to test whether the percentage of Medicaid residents is associated with change in indirect-care staffing levels. The number of indirect-care staff hours per 100 residents declined significantly following the mandated increase in nursing staff, particularly among facilities with a low percentage of Medicaid residents. This may have stemmed from a partial transfer of indirect-care to CNAs and was exacerbated in facilities that received less additional reimbursement to pay for CNA increases. © 2010, SAGE Publications. All rights reserved.
  • Digital Object Identifier (doi)

    Author List

  • Thomas KS; Hyer K; Andel R
  • Start Page

  • 555
  • End Page

  • 573
  • Volume

  • 67
  • Issue

  • 5