Nursing Home Outcomes Following the CareGivers NC Program: A Multi-Year Evaluation of Staffing and Quality Performance

The intensifying workforce crisis in nursing homes (NHs) has prompted state-level interventions such as CareGivers NC, a North Carolina (NC) initiative responding to widespread shortages of certified nursing assistants (CNAs). This study assesses whether participation in the CareGivers NC program resulted in measurable improvements in staffing hours and quality outcomes in NC NHs. Using a difference-in-differences approach with propensity score matching, we analyzed performance indicators from 2019 to Q2 2024. Compared to non-participating NHs, program participants showed a significant reduction in total and employee CNA hours, despite a slight increase in contracted hours. No consistent improvements were observed in CMS quality ratings, with a significant decline in staffing and quality measure ratings. These results highlight the limited effectiveness of workforce-only interventions in improving NH quality and emphasize the need for integrated reforms that couple staffing strategies with operational leadership, environmental assessment, policy reforms, and efforts to mitigate ageism.