SNF staffing shifts after REIT acquisition, study shows

Steady increases in licensed practical nurse and certified nursing assistant hours per resident day in skilled nursing after REIT acquisition could mean that there is some kind of “substitution effect” taking place, where facilities are substituting more expensive skilled labor for less skilled, inexpensive labor, according to David Stevenson, PhD, a professor of health policy at the Vanderbilt University School of Medicine, and R. Tyler Braun, PhD, an assistant professor of population health sciences at Weill Cornell Medical College.

The researchers spoke with LeadingAge members Monday to share their findings, published in Health Affairs, based on their use of a novel database of REIT investments in the United States, which they used to compare caregiver staffing in nursing homes in which REITs were and were not invested in.

“What we see is on the aggregate [is] increases of about 2.15% in licensed practical nurse hours per resident, and then we see about a 1.55% increase in hours per day for certified nursing assistants, and then we see about a 3.31% decrease for registered nurses,” [Braun] said.

He noted that those numbers were not significant in the aggregate, but “if you were to actually extrapolate that out by year and look at the changes by year and not just in a pre/post period, it can actually get a little more telling. After excluding the largest acquisitions, we can see that nursing homes had, on average, about a 6.25% per resident day decrease in staffing following reinvestment, [by a REIT],” [he] said. “So this may suggest that larger deals are more likely to increase LPN and CNA staffing.”