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When research conducted a decade ago documented that mortality rates actually increased when employment rates increased, health economists sought to identify the cause.  Focusing on employed workers did not explain the increased mortality rates.  A new analysis by the Center for Retirement Research at Boston College – focused on who was actually dying when employment increased – has come up with a new conclusion: "an expanding economy generates a greater scarcity of front-line caregivers in nursing homes, which may cause more deaths among the elderly."[1]  The researchers conclude that "rising mortality during good economic times is largely driven by additional deaths among people over age 65 in nursing homes, particularly women."

The researchers explained how they came to this unsettling conclusion.  They found, first, that "deaths among people ages 65 and older accounted for 75 percent of the 6,700 additional deaths," and among older women, in particular, for "55 percent of the additional deaths."  A 1% decline in unemployment was correlated with a 0.40% increase in mortality for older women.

Next they determined that "changes in death rates for older people were primarily driven by employment changes among younger individuals [italics in original]."  With that finding, they examined "whether changing employment patterns in health-care facilities" could explain the increased mortality rates of elderly women, who typically outlive their husbands and are more likely to live in care facilities at the end of their lives. 

Past research has documented that employment levels in the health care sector "decline during economic expansions as low-paid, low-skill health workers [such as nurse aides in nursing facilities] find better jobs elsewhere." 

The researchers found "the effect of a 1-point decline in the unemployment rate on nursing home deaths was large – a 0.56 percent increase – and statistically significant."  Unemployment rates had no impact on deaths elsewhere.  Finally, they found that mortality rates increased more in states that had higher percentages of their elderly population living in nursing facilities.


More than a decade ago, the federal government reported that most nursing homes are seriously understaffed.[2]  Resident care needs have increased since then, but nurse staffing levels remain too low in many facilities.    

The analysis and conclusion by Center for Retirement Research at Boston College reinforce the point made repeatedly in the Center's Alerts on nursing home issues: that nurse staffing is the most critical component and predictor of nursing home quality.  Without sufficient numbers of adequately trained nursing staff, nursing homes cannot provide good care to residents.


[1] Ann Huff Stevens, Douglas L. Miller, Marianne Page, and Mateusz Filipski, Center for Retirement Research at Boston College, "Why Do More People Die During Economic Expansions?" (April 2012, No. 12-8), available at
[2] Centers for Medicare & Medicaid Services, Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II (Winter 2001) (Found 97% of facilities failed to meet one or more staffing requirements (1.15-1.3 hours licensed staff; 2.4-2.8 hours aide), and 52% failed to meet all staffing requirements, to prevent avoidable harm to residents; simulation found 91% lacked sufficient nursing staff to meet five key care processes required by Reform Law (dressing/grooming, exercise, feeding assistance, changing wet clothes and repositioning, toileting); more than 40% of facilities would need to increase aide staff by 50% or more; more than 10% of facilities would need to increase aide staff by more than 100%.

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