UMBC School of Public Policy

Permanent URI for this collectionhttp://hdl.handle.net/11603/59

The UMBC School of Public Policy includes the master of public policy (MPP) and PhD degree programs, and the Maryland Institute for Public Policy and Analysis Research (MIPAR). Established after four decades of sustained growth, the School consists of nine full-time faculty, more than 30 affiliated faculty from the departments of economics, sociology, political science, and policy analysis. MIPAR, with $23 million in active research grants, links the analytical resources of the University with policymakers in the state and region, conducting opinion research, policy analyses, and program evaluations on a variety of topics. MIPAR activities are supported by federal, state, and local governmental agencies, foundations, and corporations.

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Leveraging State Data Sources to Improve Analysis of Medicaid Participant Race and Ethnicity
(2024-06-29) James, Parker; Woodcock, Cynthia; Middleton, Alice; Idala, David; Smirnow, Alexis
The Economic Impact of Medicaid Expansion in Mississippi
(2024-02-20) Henderson, Morgan; Woodcock, Cynthia
Hilltop Principal Data Scientist Morgan Henderson, PhD, and Executive Director Cynthia Woodcock, MBA, presented Hilltop research to the Mississippi House Medicaid Committee. The research � a 2021 economic analysis of Medicaid expansion in Mississippi � was commissioned by the Center for Mississippi Health Policy, a nonprofit, non-partisan organization.
Sustainability of a dual language program during and beyond COVID-19 challenges
(Taylor & Francis, 2024-10-28) Mata-McMahon, Jennifer; Williams, Sabrina; Daramola, Adebola; Kruse, Lance; Hossain, Shahin
This study evaluates the Dual Language Program (DLP) implemented at a Title I public school in Baltimore City during the 2019–2020 and 2020–2021 school years. Building on previous research, the DLP's implementation, sustainability, and effects on students’ learning outcomes were examined. Utilizing a mixed-methods approach, the study’s second phase included participants from the school’s mainstream, English-only program (MP), enriching the overall understanding of the school community’s perception of the program. Data were collected through surveys, classroom observations, and standardized assessments—the DIBELS and the iReady Diagnostic assessments. Findings showed challenges with curriculum standardization and prevalent misconceptions about bilingualism. Nevertheless, the program's successes were evident in DLP students’ enhanced engagement, parental involvement, and community support. Despite the challenges of the COVID-19 pandemic, the DLP demonstrated its capacity for scaleability and sustainability. During the 2020–2021 school year, regardless of virtual learning, DLP students not only maintained but, in the case of Cohort 1, showed greater growth in reading skills compared to MP students, with Cohort 3 DLP students improving to reach statistically similar performance levels to their MP peers. Findings indicate that the DLP has the potential to serve as a sustainable educational program, fostering both dual language proficiency and academic outcomes.
The Appropriate Division of Regulatory Labor
(Springer, 2024-10-22) Brennan, Timothy
Should national postal authorities or postal operators, experts in postal economics and policy, also become experts in estimating environmental costs and benefits? The alternative view is that there should be a “division of regulatory labor,” akin to the division of productive labor going back to Adam Smith. An environmental regulator can incorporate pollution and global warming costs across the economy, while postal authorities address postal policy goals taking the costs determined by environmental policy into account. A potential boundary between postal and environmental policy is pertinent also to national or transnational regulation of electric transmission and distribution grids. This issue has recently arisen in antitrust, as policymakers express greater sympathy for considerations beyond consumer benefit, including social equality and environmental sustainability. Employment and equity are arguably (and controversially) separable as well. However, there may be limits to the division of regulatory labor. Competition authorities in the USA have not been reluctant to expect other regulators in the USA to incorporate competitive effects in designing their regulations. Moreover, often sectoral regulators are expected to balance multiple policy considerations. One also needs to recognize that other regulations, such as climate-related carbon pricing, may not be in place.
The Impact of Medicaid Expansion on Medicare Quality Measures
(2024-11-05) Algrain, Hala; Cardosa, Elizabeth; Desai, Shekha; Fong, Eugene; Ringoir, Tanguy; Ashqar, Huthaifa
The Affordable Care Act was signed into law in 2010, expanding Medicaid and improving access to care for millions of low-income Americans. Fewer uninsured individuals reduced the cost of uncompensated care, consequently improving the financial health of hospitals. We hypothesize that this amelioration in hospital finances resulted in a marked improvement of quality measures in states that chose to expand Medicaid. To our knowledge, the impact of Medicaid expansion on the Medicare population has not been investigated. Using a difference-in-difference analysis, we compare readmission rates for four measures from the Hospital Readmission Reduction Program: acute myocardial infarction, pneumonia, heart failure, and coronary artery bypass graft surgery. Our analysis provides evidence that between 2013 and 2021 expansion states improved hospital quality relative to non-expansion states as it relates to acute myocardial infarction readmissions (p = 0.015) and coronary artery bypass graft surgery readmissions (p = 0.039). Our analysis provides some evidence that expanding Medicaid improved hospital quality, as measured by a reduction in readmission rates. Using visualizations, we provide some evidence that hospital quality improved for the other two measures as well. We believe that a refinement of our estimation method and an improved dataset will increase our chances of finding significant results for these two other measures.
The Effects of a Statewide Ban on School Suspensions
(IZA- Institute of Labor Economics, 2024-10) Lincove, Jane; Mata, Catherine; Cortes, Kalena E.
This research analyzes the implementation of a school suspension ban in Maryland to investigate whether a top-down state-initiated ban on suspensions in early primary grades can influence school behavior regarding school discipline. Beginning in the fall of 2017, the State of Maryland banned the use of out-of-school suspensions for grades PK-2, unless a student posed an “imminent threat” to staff or students. This research investigates (1) what was the effect of the ban on discipline outcomes for students in both treated grades and upper elementary grades not subject to the ban? (2) did schools bypass the ban by coding more events as threatening or increasing the use of inschool suspensions? and (3) were there differential effects for students in groups that are historically suspended more often? Using a comparative interrupted time series strategy, we find that the ban is associated with a substantial reduction in, but not a total elimination of, out-of-school suspensions for targeted grades without substitution of in-school suspensions. Disproportionalities by race and other characteristics remain after the ban. Grades not subject to the ban experienced few effects, suggesting the ban did not trigger a schoolwide response that reduced exclusionary discipline.
Climate-related disasters and transparency: Records and the United States Federal Emergency Management Agency
(Wiley, 2024-09-12) Sterett, Susan
Objective Many governments aim for transparency for accountability. Transparency and its processes contribute to governing climate. The transparency agenda focuses on sharing records to inform the public. In the United States, accessible records also add to decision-making processes since records are useful to contest decisions. Few people put together the two kinds of transparency, sharing and challenging. Analyzing both is critical as calls for acting on climate-related disasters grow. Method In the United States, the Federal Emergency Management Agency (FEMA) shares records. The Freedom of Information Act (FOIA) is one route to access FEMA's records. To assess transparency, I coded FEMA's 2019 FOIA log for requester and record requested. Years of damaging, notable disasters preceded 2019, but 2019 precedes pandemic disruptions. Result Requesters can make requests likely to be useful instrumentally, concerning assistance and insurance. Journalists and scholars request records useful to conceptualizing governing disaster to include both individual political officials and aggregate bureaucratic policy. Instrumental requests dominate, as they do for other agencies. Conclusion This article answers the call in recent studies of transparency, policy, and of disaster governance to track how policies embed power. Assessing record requests contributes to understanding the accountability in freedom of information.
Telehealth as a Tool to Transform Pediatric Care: Views from Stakeholders
(Mary Ann Liebert, 2023-12) Jones, Emily; Cross-Barnet, Caitlin
Background and Objectives: The 2020 COVID-19 pandemic generated rapid telehealth expansion. Most prior telehealth studies focus on a single program or health condition, leaving a knowledge gap regarding the most appropriate and effective means of allocating telehealth services and funding. This research seeks to evaluate a wide range of perspectives to inform pediatric telehealth policy and practice.Methods: In 2017, the Center for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation (Innovation Center) issued a Request for Information to inform the Integrated Care for Kids model. Researchers identified 55 of 186 responses that addressed telehealth and analyzed them based on grounded theory principles overlaid with a constructivist approach to contextualize Medicaid policies, respondent characteristics, and implications for specific populations.Results: Respondents noted several health equity issues that telehealth could help to remedy, including timely care access, specialist shortages, transportation and distance barriers, provider-to-provider communication, and patient and family engagement. Implementation barriers reported by commenters included reimbursement restrictions, licensure issues, and costs of initial infrastructure. Respondents raised savings, care integration, accountability, and increased access to care as potential benefits.Discussion and Conclusions: The pandemic demonstrated that the health system can implement telehealth rapidly, although telehealth cannot be used to provide every aspect of pediatric care such as vaccinations. Respondents highlighted the promise of telehealth, which is heightened if telehealth supports health care transformation rather than replicating how in-office care is currently provided. Telehealth also offers the potential to increase health equity for some populations of pediatric patients.
Intensive Approaches to Prenatal Care May Reduce Risk of Gestational Diabetes
(Mary Ann Liebert, 2021-05) Benatar, Sarah; Paez, Kathryn; Johnston, Emily M.; Lucado, Jennifer; Castillo, Graciela; Cross-Barnet, Caitlin; Hill, Ian
Objectives: To observe gestational diabetes mellitus (GDM) prevalence among participants receiving enhanced prenatal care through one of three care models: Birth Centers, Group Prenatal Care, and Maternity Care Homes.Materials and Methods: This study draws upon data collected from 2014 to 2017 as part of the Strong Start II evaluation and includes data from nearly 46,000 women enrolled across 27 awardees with more than 200 sites throughout the United States. Descriptive and statistical analyses utilized data from participant surveys completed upon entry to the program and a limited chart review.Results: A total of 6.3% of Strong Start participants developed GDM during their pregnancy. Rates varied significantly and substantially by model. After adjusting for participant risk factors, we find that Birth Center participants of all races and ethnicities experienced significantly lower rates of GDM than women of the same race/ethnicity in Maternity Care Homes.Conclusions: The lower rates of gestational diabetes among women receiving Birth Center prenatal care suggest the need for further investigation of how prenatal care approaches can reduce GDM and address health disparities.
Exposing Postdocs to Multiple Institutional Types: A PROMISE-ing Intervention to Prepare Biomedical Faculty
(Frontiers, 2024-10-15) Cresiski, Robin H.; Ugarte, Fadel; Harris, Lakeisha; Clark, Jessica
Biomedical faculty positions require experience as a postdoctoral scholar (or "postdoc"). However, there is a current misalignment with postdoctoral training and workforce needs within higher education. The majority of postdocs are trained to be research faculty while completing fellowships at research-intensive universities, despite the fact that the majority of US higher educational institutions (where these postdocs may be employed) focus on undergraduate education. This leads to postdoctoral scholars not having the opportunity to gain exposure to different institutional types where they could be employed. Importantly, they also lack the opportunity to build a network or receive mentorship from faculty at non-R1 institutions. This may be particularly true of underrepresented scholars. In this brief report, we describe the practice of the NSF-funded PROMISE Academy Alliance to bridge this training gap and support greater preparation for faculty careers at an array of institutional types by leveraging collaboration within a state university system. A survey of PROMISE Academy Fellows about their structured experiences engaging with other campuses (e.g., campus tours, workshops, speaking opportunities) reveals that visits to other campuses within the state system are informative and impactful, both on their research and their employment interests. The positive findings can hopefully inspire easy-to-implement changes in postdoctoral support across other university systems or regional consortia.
Does Charter School Autonomy Improve Matching of Teacher Attributes with Student Needs?
(2024-09) Lincove, Jane; Rogers, Salem; Handler, Alex; Kilbride, Tara; Strunk, Katharine O.
We examine the efficiency of traditional school districts versus charter schools in providing students with teachers who meet their demographic and education needs. Using panel data from the state of Michigan, we estimate the relationship between enrollment of Black, Hispanic, special education, and English learner students and the presence of Black, Hispanic, Special Education, and ESL teachers, and test whether this relationship differs at charter and traditional district-run schools. Because charter schools typically have less market power in hiring than large districts, we compare charter school employment practices to traditional public schools in districts of comparable size. Our results suggest that charter schools are more likely to employ same race teachers for Black students but not Hispanic students, and districts schools are slightly better at providing ESL and SPED teachers. We conclude that charter autonomy does not necessary generate better student-teacher matches, but Michigan charters may occupy a market niche by serving Black students and staffing Black teachers.
Limits of prenatal care coordination for improving birth outcomes among Medicaid participants
(Elsevier, 2022-11-01) Cross-Barnet, Caitlin; Benatar, Sarah; Courtot, Brigette; Hill, Ian
Maternity Care Homes (MCHs) intend to address clinical and psychosocial needs for perinatal patients and are commonly implemented for Medicaid beneficiaries. Rigorous evidence supporting MCHs' effectiveness for improving birth outcomes is thin, but most studies consider only clinical and demographic factors from administrative data. To assess birth outcomes with controls for psychosocial variables known to affect them, this paper considers quantitative participant-level data from the Strong Start for Mothers and Newborns prenatal care initiative, with qualitative case study data to further contextualize results. From 2013 to 2017, Strong Start served over 45,000 Medicaid beneficiaries in 32 states, D.C., and Puerto Rico though MCHs, group prenatal care, or freestanding birth centers. Participant data included risks screens for food insecurity, depression, anxiety, pregnancy intention, and intimate partner violence, in addition to clinical and demographic information. After clinical, demographic and psychosocial risks were controlled in a regression model, Strong Start birth center participants showed significantly lower rates of preterm birth, low birthweight, and cesarean section relative to MCH participants (p < .01). In group prenatal care, White participants showed lower rates of preterm birth (p < .01) and Black participants showed lower rates of low birthweight (p < .05) relative to MCH participants. Strong Start participants reported appreciation for MCH care managers' support, but community and clinical referrals often had long waiting lists or were inaccessible. Transformative care models focusing on provider continuity, relationship building, and patient activation may offer more promise for improving birth outcomes than supplementing medical models with care management and other resources.
COVID-19 in Adults with Disabilities: Disparities in Prevalence, Health Care Access and Use and Employment Outcomes
(2024-08-09) McLaren, Zoë; Miller, Nancy A.
A Cross-national Comparison of COVID-19 and Mental Health: Understanding Social Trust.
(2024/01/01) Hunter-Cevera, Jonathan; McLaren, Zoe ZM Adler, Marina MA; School of Public Policy; Public Policy
The COVID-19 pandemic caused a global challenge that many countries were not well equipped for. The present study examined why certain countries did better in terms of deaths caused from the novel virus and mental health outcomes during the first 17 months of the pandemic. Current research has examined many government and policy related variables at an attempt to explain differences of COVID-19 outcomes between and within countries. Studies also examine the complicated changing concept of social capital as well. The goal of this research was to examine countries (N=50) in a cross-national setting testing government/economic, welfare states, Non-pharmaceutical intervention policies, and social trust variables on deaths from COVID-19 and adverse mental health. Various multiple regression series were run using mediation, moderation, and quadratic techniques. The results suggested that having higher social trust in the form of trusting other citizens and trusting government and public institutions may have had a strong influence in reducing countries COVID-19 deaths and adverse mental health outcomes. Countries’ public health officials and government should take into account the public levels of social trust before implementing NPIs and vaccination rollout. A country’s level of social trust may be an important factor to successfully navigate through a pandemic.
Bouncing Forward: Exploring Nonprofit Resilience Through Emergency Management
(2024/01/01) De Oro, Grace Catherine; Hamilton Edwards, Lauren; School of Public Policy; Public Policy
Resilience is often associated with the ability to recover quickly or bounce back. However, often, recovery does not look like a return to "normal" or homeostasis. Nonprofit organizations are essential to providing services in response to emergencies, and their involvement builds communities' capacity to deal with future disasters. Nonprofit organizations' response to the Coronavirus (COVID-19) pandemic has grown almost as quickly as the news and fear of the virus spreading across all continents. The pandemic challenged nonprofits' limits, management, and preparedness everywhere, often exposing limited capacity to bounce back while helping the populations and communities they serve. This dissertation research focuses on two major exploratory questions by utilizing a systematic literature review and a case study on emergency management nonprofits. First, what is resilience, and how can we measure it? and second, what does organizational resilience look like in nonprofit organizations? The systematic literature review and theoretical background of interdisciplinary literature establish this study of resilience from the perspective of nonprofit organizations. The literature is used to develop a framework in which resilience is a process, not a characteristic of an individual, organization, or community. By conducting a case study on emergency management nonprofits, this dissertation examines how the experience and response to the COVID-19 pandemic impacted the organization through primary data collection and interviews with nonprofit practitioners. Risk avoidance, risk management, and the control of risk, with the capacity to cope resiliently, are used to build a relationship between resilience and emergency management (Wildavsky,1998). The findings of this study have direct implications for how future scholarship defines resilience and stresses the importance of actively including and involving practitioners in the field. The COVID-19 pandemic provides a unique situation as risk and perceived risk were completely unknown. Nonprofit organizations acted in the best way they knew how and to their capacity. The findings also include a conversation on mission pivot, the short-term and long-term impacts of a disaster like COVID-19, and participants' reactions to COVID-19.
Economic dimensions of violence against women: policy interventions needed
(springer, 2024-08-07) Miah, MD Rafid Abrar; Sifat, Ridwan Islam
Violence against women is a common phenomenon in all societies, and in countries where gender inequality persists, such as Bangladesh, this issue is even more pronounced. Violence against any entity often stems from subordination, and it is generally accepted that empowering women can help prevent violence against them. The objective of the study is to unmask how different the role of economic performance of both men and women is impacting types of violence against women. With numerical data from the World Bank and Ain o Salish Kendra (ASK), we used Pearson correlation and OLS regression to extract the results from the raw data collected. The study finds that male unemployment is positively correlated with violence against women (including domestic violence, dowry-induced violence, and rape), while female unemployment shows an inverse relationship with the severity of violence. The findings emphasize the urgent need for policy interventions to address the underlying factors, effectively mitigate violence against women, inform policymakers and contribute to the development of effective strategies to promote a more equitable society.
URCAD 2024
(UMBC Center for Social Science Research, 2024-05-01) Anson, Ian; Kim, Jean; Awan, Pakeeza; Joslow, Rachael; Hoang, Lien; Osei, Emmanuella; Cline, Carrington; Byrd, Ziegfried; Anson,Ian; Mallinson,Christine; Filomeno,Felipe; Kim,Jean; Moreland,D’Juan; Barnes,Amy; Ralston,Myriam
On today’s episode we hear about a series of fantastic presentations from UMBC’s Undergraduate Research and Creative Achievement Day, also known as URCAD. During URCAD, students from across the social science disciplines presented their excellent research to the campus community and beyond. Our special host for today’s episode is our production assistant, Jean Kim. Stay tuned for this wonderful celebration of undergraduate achievement–in podcasting as well as in social science research!
Going Beyond Giving: A Qualitative Case Study of Scholarship Donor’s Involvement with their Recipients and the Impact on Student Retention and Completion at a Mid-Sized Community College
(2024-01-01) Sears, David Michael; Lincove, Jane A.; School of Public Policy; Public Policy
With community colleges struggling with the completion rates of their students, it is important to understand the social and academic integration of community college students and their relationships to retention and completion. Research focuses on the critical role of internal college actors such as faculty, staff, and students in these integrations, but a gap in the literature exists as to the role of external stakeholders, particularly scholarship donors, in these integrations. This research will use a single qualitative case study design to explore the impact of donor involvement with the students they support with scholarships in the Achieving Collegiate Excellence and Success (ACES) program at Montgomery College. The purpose of the study is to assess how and why this donor engagement with students influences their integrations and motivates them to achieve their academic goals at rates higher than other students in the program who have not received donor-given scholarships or whose donors are not engaged. The case study design will incorporate three components: interviews and focus groups with ACES students, alumni, donors, and staff, as well as document analysis of thank you letters from scholarship recipients to the donors. The research will examine this question through the theoretical framework of Tinto’s Theory of Student Persistence (1993). This theory focuses on faculty, staff, and student interactions impacting academic and social integration. This research looks to expand upon the theory that external stakeholders, such as engaged scholarship donors, play critical roles in social and academic integration of community college students. The donors do not supplant the critical role of faculty, staff, and students in the integrations, as Tinto notes, but rather complement the role in various ways to enhance student academic and social integration leading to retention and college completion. If students cite the importance of donor involvement in their integrations to college life, leading to retention and completion, more programs with greater donor involvement with need-based scholarship recipients may be implemented by community colleges to increase student completion. Community colleges may be more intentional in their approach to philanthropy for scholarships, the role of donors with students, and how they complement the role of faculty, staff, and other students in the scholarship recipients’ social and academic integrations.
The Impacts of Select State-Level Policies on Increasing the Educational Attainment of Undocumented Immigrant Youth
(2024-01-01) Kitchin, James; Gindling, Tim H Dickson, Lisa; School of Public Policy; Public Policy
Undocumented children have a right to a public k-12 education in the United States, however there is no standard approach to higher education. About half of states allow undocumented immigrants to attend public colleges and universities at in-state rates of tuition (ISRT) and a subset of these also allow them access to state financial aid. This dissertation measures the impacts of these state-level policies that attempt to increase access to higher education for this group and studies the relationship between ISRT policies and college counseling of undocumented students at the high school level.The dissertation starts by measuring the impact of ISRT policies, financial aid policies, and DACA on a variety of educational and employment outcomes for undocumented immigrant youth. It uses Current Population Survey basic monthly data from July 1999 – December 2015. A difference-in-differences research design is operationalized through a standard linear regression two-way fixed-effects model. The findings include a 4-percentage point increase in college attendance and a 2-percentage point increase in college graduation due to the implementation of ISRT policies. The dissertation also finds that granting access to state financial aid can double the impact of the ISRT policy. DACA serves to decrease the college enrollment and increase the employment of undocumented immigrant youth. The dissertation then reacts to emerging literature in the field of econometrics that critiques the difference-in-differences research design operationalized through the standard linear regression two-way fixed-effects model when there are multiple groups that adopt the treatment at different times. It uses the American Community Survey from 2001-2019 and the Census 2000 1% sample to apply a newer quantitative method, the Calloway-Sant’Anna difference-in-differences estimator. Even with a new, more robust quantitative method ISRT policies increase the college enrollment of undocumented immigrants by, on average, 3 percentage points. They increase college graduation rates by, on average, 1 percentage point. However, there is a lot of heterogeneity present in the results that have large policy implications. This is explored in depth. Lastly, the dissertation uses the High School Longitudinal Study of 2009 to perform a Latent Class Analysis that identifies three typologies of college counseling opportunity structures in U.S. high schools. It then uses regression analysis to explore the relationship between attending high school in a state with an ISRT policy and the rate that high school counselors and undocumented immigrant students speak about college in the ninth grade. States with an ISRT policy have a smaller percentage of high schools with counseling opportunity structures that encourage college going than states without an ISRT policy. Similarly, students who are undocumented are the least likely to attend schools with counseling opportunity structures that prioritize college. Even so, high school counselors and undocumented students in the ninth grade are more likely to speak about college than are high school counselors and documented or nonimmigrant ninth graders. However, this is only the case in states that have adopted an ISRT policy.
United States Nursing Homes: The Impact of Regulation on Quality
(2024-01-01) Harshman, Stephanie; Miller, Nancy; School of Public Policy; Public Policy
The United States nursing home industry has historically faced pervasive issues that impact quality of care and quality of life for nursing home residents. In 2016, efforts were made to address quality issues within nursing homes through an overhaul of regulatory policy. The COVID-19 pandemic not only impacted implementation of the 2016 policy revisions, but also diminished the ability to collect data and analyze the effectiveness of the updated regulatory policy. Recent reports have indicated that nursing homes continue to struggle with meeting minimal quality standards. With public health emergency restrictions lifted and normal nursing home operations resuming, new opportunities are available to analyze nursing home quality and regulatory enforcement. The purpose of this dissertation is to evaluate the current state of quality in United States nursing homes and how regulations have impacted quality in this sector. A scoping literature review finds that research on nursing home quality largely focuses on the quality metrics developed by the Centers for Medicare and Medicaid Services (CMS). This includes the CMS Five-Star Rating System and its components. Current available literature infrequently includes qualitative research or full data encompassing the 2016 policy revisions. Qualitative and quantitative methods are used in this dissertation to fill these identified gaps. Qualitative interviewing gives a voice to the workers whose care performance directly impacts the outcomes used by CMS to measure quality in nursing homes. The qualitative interviews performed as part of this dissertation reveal that broadly, frontline worker views on quality do not align with quality metrics utilized by CMS. Bridging the gap between policy and frontline worker experience is vital to ensure regulations elicit action from those providing care. Findings from this research indicate that regulatory policy is not achieving this. Quantitative research identifies trends in CMS nursing home quality using data pre and post policy implementation. The quantitative analysis finds that most quality outcomes either declined or remained unchanged since 2016, with for-profit nursing homes consistently performing worse on quality metrics when compared to nonprofit and public nursing homes. The results of the quantitative analysis reveal a failure of the 2016 policy revisions intended to improve nursing home quality throughout the country. This dissertation concludes that current regulations are not having a positive impact on quality in US nursing homes. Frontline workers are mostly uninfluenced by regulatory enforcement methods when discussing their caregiving behaviors. Nursing home quality as measured by CMS has declined throughout the country, despite the 2016 policy revisions intended to improve it. Policymakers must make efforts to include frontline worker input in future policy adaptations and either revise the metrics used to measure nursing home quality or invest in further quality improvement programming to achieve the desired outcome of higher quality in US nursing homes.

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