All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Monica S Aswani

Nancy Borkowski

Ganisher Davlyatov

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


The Patient Driven Payment Model (PDPM) brought about a paradigm shift in the way skilled nursing facilities are reimbursed, by linking complexity of care to beneficiary need, expanding case-mix adjusted components by including a non-therapy ancillary and speech language pathology component, and limiting the volume of therapy services provided. The COVID-19 pandemic wreaked havoc upon the nursing home industry that gave rise to high patient and staff infections and fatalities, declining occupancy rates, and nursing shortages, compelling the Department of Health and Human Services to provide $4.9 billion in CARES Funding to skilled nursing facilities (SNFs). Using Payroll Based Journal, Nursing Home Compare, LTCFocus, Area Health Resource File, Medicare Cost Reports, HHS Provider Relief Fund, Nursing Home COVID-19 Public File, and the COVID-19 Data Tracker, the goal of this study was to determine if PDPM affected both nurse staffing and therapy staffing intensity during the COVID-19 pandemic. A random effects model was used to identify changes in nurse and therapy quarterly staffing intensity between January 1, 2020, and September 30, 2021. The researcher examined the effects of PDPM on resident per day direct care nursing and therapy staffing levels. Beginning the second quarter of 2020 through the third quarter of 2021, SNFs on average significantly reduced nurse staffing hours and therapy assistant hours, while therapy staffing hours increased, relative to the first quarter iv of 2020. These reductions were larger in SNFs that are designated for-profit and chain affiliated. One could assume the overall nursing staff reductions were the result of nursing shortages, high payroll costs associated with nurse staffing, and diverting expenses toward other needs such as improved infection control programs and increased allocation of personal protective equipment (PPE). There was no meaningful association with CARES Funding and nursing and therapy staffing levels. Further research is needed to assess the allocation of all COVID-19 relief monies distributed to nursing facilities with respect to nursing and therapy staffing intensity.



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