For many years, advocates for nursing home residents have said that nursing facilities significantly improve their staffing levels when they anticipate that surveyors will soon be on-site to conduct an annual inspection. A new study confirms advocates’ anecdotal experience. “Government Monitoring of Health Care Quality: Evidence from the Nursing Home Sector,” Working Paper 34037, National Bureau of Economic Research (Jul. 2025), a nationwide study by Yiqun Chen & Marcus Dillender, finds that nursing facilities respond to surveys – increasing the work hours of nursing and other staff, increasing registered nurse hours, reducing admissions, increasing temporary discharges, and improving certain care practices (such as slight decline in use of antipsychotic drugs) – but immediately revert to prior staffing levels and behavior when the survey ends. The study finds that for-profit facilities are more likely to increase staff hours and to reduce admissions during surveys than other facilities.
Although the researchers recognize that nursing home quality matters (finding reduced mortality rates at 90 days in higher rated facilities), they recognize that facilities’ gaming of inspections “can overrate firms’ quality performance and underdetect quality deficiencies relative to their typical levels.”
July 17, 2025 – T. Edelman