Abstract
Purpose: The purpose of this study was to examine the influence of political, socioeconomic, and demographic factors on nursing home regulatory activity between California and Florida from 2009 through 2016.Theoretical Framework: The theoretical framework of this study was based on the research foundations of principal-agent theory.Methodology: This study analyzed secondary data from the Centers for Medicare and Medicaid Services' Certification and Survey Provider Enhanced Reporting (CASPER) system to examine the volume and severity of deficiencies cited during nursing home inspections, nurse staffing hours per resident for nursing facilities, facility ownership status, and the primary payer source of nursing home residents from 2009 to 2016. During the same period, the study used data from the U.S. Census Bureau and U.S. Bureau of Labor Statistics databases on median household income, poverty rates, and income inequality in California and Florida and from the California Secretary of State, California Office of Legislative Council, California State Assembly Office of the Chief Clerk, Florida Division of Elections, Florida Senate, and Florida House of Representatives websites on the political affiliation of the governor and the legislature in these 2 states. Descriptive statistics were used identify patterns that emerged from multiple years of data.Findings: In relation to the principal-agent model, the study finds a correlation between California's change in governorship from Republican to Democrat in 2011 and the sharp increase in deficiencies causing harm or jeopardy to residents from 2012 to 2016. Also, the study found a correlation between California's increase in the percentage of for-profit operated facilities and the increase in deficiencies causing harm or jeopardy to residents from 2011 to 2016.Conclusions and Recommendations: The study data support underlying assumptions that state governorship can influence nursing homes. Future studies should be extended to other U.S. states and territories and should examine interaction among variables that influence inspectors' citation of deficiencies. Also, researchers could analyze how the variables examined in the study could have had an impact on quality of care in nursing homes during the coronavirus pandemic.