Braun Robert Tyler, Williams Dunc, Stevenson David G, Casalino Lawrence P, Jung Hye-Young, Fernandez Rahul, Unruh Mark A
Robert Tyler Braun (
Dunc Williams, Medical University of South Carolina, Charleston, South Carolina.
Health Aff (Millwood). 2023 Feb;42(2):207-216. doi: 10.1377/hlthaff.2022.00278. Epub 2023 Jan 25.
In 2021 real estate investment trusts (REITs) held investments in 1,806 US nursing homes. REITs are for-profit public or private corporations that invest in income-producing properties. We created a novel database of REIT investments in US nursing homes, merged it with Medicare cost report data (2013-19), and used a difference-in-differences approach within an event study framework to compare staffing before and after a nursing home received REIT investment with staffing in for-profit nursing homes that did not receive REIT investment. REIT investment was associated with average relative staffing increases of 2.15 percent and 1.55 percent for licensed practical nurses (LPNs) and certified nursing assistants (CNAs), respectively. During the postinvestment period, registered nurse (RN) staffing was unchanged, but event study results showed a 6.25 percent decrease in years 2 and 3 after REIT investment. After the three largest REIT deals were excluded, REIT investments were associated with an overall 6.25 percent relative decrease in RN staffing and no changes in LPN and CNA staffing. Larger deals resulted in increases in LPN and CNA staffing, with no changes in RN staffing; smaller deals appeared to replace more expensive and skilled RN staffing with less expensive and skilled staff.
2021年，房地产投资信托基金（REITs）对1806家美国疗养院进行了投资。REITs是投资于创收性房产的营利性公共或私人公司。我们创建了一个关于REITs对美国疗养院投资的全新数据库，将其与医疗保险成本报告数据（2013 - 2019年）合并，并在事件研究框架内采用差异法，比较疗养院获得REIT投资前后的人员配备情况与未获得REIT投资的营利性疗养院的人员配备情况。REIT投资分别与执业护士（LPNs）和注册护理助理（CNAs）的平均相对人员配备增加2.15%和1.55%相关。在投资后时期，注册护士（RN）的人员配备没有变化，但事件研究结果显示，在REIT投资后的第2年和第3年，RN人员配备下降了6.25%。排除三大REIT交易后，REIT投资与RN人员配备总体相对下降6.25%相关，而LPN和CNA人员配备没有变化。规模较大的交易导致LPN和CNA人员配备增加，RN人员配备没有变化；规模较小的交易似乎用成本较低、技能较低的员工取代了成本较高、技能较高的RN员工。
