Determinants of Nursing Home Quality*

This study explores the determinants of nursing home quality, providing a theoretical framework that takes into account structural, process, and environmental factors. It asks: Do structural, process, and environmental factors influence nursing home quality? If so, which is the strongest predictor of quality? And does market competition have a positive impact on nursing home quality? Based on relevant literature, this study developed hypotheses and tested them with multiple regression models. The models show that most (but not all) structural, process, and environmental variables have a statistically significant relationship with nursing home quality. The ratio of nursing assistant hours to total nursing hours has the strongest positive influence on quality of care. But market competition does not have a positive effect on nursing home quality; this implies that competition may not a good way to improve the quality of nursing home care.