Skilled Staff Research Articles

Impact of community health interventions on maternal and child health indicators in the upper east region of Ghana

BackgroundThis paper reports on results of a health system strengthening implementation research initiative conducted the Upper East Region of northern Ghana. Transformative interventions to accelerate and strengthen the health delivery were implemented that included empowering community leaders and members to actively participate in health delivery, strengthening the referral systems through the provision of community transport systems, providing basic medical equipment to community clinics, and improving the skills of critical health staff through training.MethodsA mixed method design was used to evaluate the impact of the interventions. A quantitative evaluation employed a flexible research design to test the effects of various component activities of the project. To assess impact, a pre-versus–post randomized cluster survey design was used. Qualitative research was conducted with focus group data and individual in depth interviews to gauge the views of various stakeholders associated with the implementation process.ResultsAfter intervention, significant improvements in key maternal and child health indicators such as antenatal and postnatal care coverage were observed and increases in the proportion of deliveries occurring in health facilities and assisted by skilled health personnel relative to pre-intervention conditions. There was also increased uptake of oral rehydration salts (ORS) for treatment of childhood diarrhoea, as well as marked reductions in the incidence of upper respiratory infections (URI).ConclusionsA pre-and post-evaluation of impact suggests that the programme had a strong positive impact on the functioning of primary health care. Findings are consistent with the proposition that the coverage and content of the Ghana Community-based Health Planning and Services programme was improved by program interventions and induced discernable changes in key indicators of health system performance.

Determinants of neonatal, infant and under-five mortalities: evidence from a developing country, Bangladesh

We investigated the macroeconomic determinants of neonatal, infant, and under-five mortalities in Bangladesh for the period 1991–2018 and discuss implications of the United Nations’ Sustainable Development Goal 3 (SDG 3) and Millennium Development Goal 4 (MDG 4) for developing countries. We used annual time series data and the econometric techniques of Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS) regressions for analysis. Determinants most effective in combating neonatal, infant, and under-five mortalities include variables such as ‘protecting newborns against tetanus’, ‘increasing healthcare expenditure’, and ‘making sure births are attended by skilled healthcare staff’. Employing more healthcare workers and assuring more and improved healthcare provisions can further reduce the neonatal, infant, and under-five mortalities. Developing countries with similar macroeconomic profiles can achieve similar SDG 3 and MDG 4 outcomes by emulating the policies and strategies Bangladesh applied to reducing child mortalities over the last three decades.

The McKinsey’s 7-S model framework for assessment of challenges faced by teachers of children with autism spectrum disorders in the Limpopo province, South Africa

Background: The number of children with autism spectrum disorder (ASD) is rapidly increasing globally and requires a supportive educational system to meet the needs of these children.Aim: The study assessed challenges faced by teachers of children with ASD in the public special schools of the Limpopo province, South Africa.Setting: The study was conducted in seven public special schools in the Limpopo province, South Africa.Methods: Face-to-face semistructured interviews were conducted with 12 teachers regarding the challenges they face in educating children with ASD. Tesch’s inductive, descriptive open coding technique enabled the researcher to analyse and report, subthemes that emerged from this qualitative explorative and descriptive data. Measures to ensure trustworthiness and ethical considerations were carried out throughout the study.Results: Analysis of the interviews revealed that the structure and systems of special schools do not support the educational needs of children with ASD. The strategic plans and policy framework on inclusive education are not being executed adequately. Learning for ASD children is not supported because of substandard infrastructure, curricula, lack of teaching material, health practitioners, unbalanced teacher–learner ratio, inadequate staff skills, school culture, shared beliefs and lack of management support.Conclusion: The study revealed challenges faced by special education teachers indicating the influence on the provision of high-quality education to children with ASD. The Department of Basic Education at the national level should monitor all special schools regularly, provide the necessary support and ensure that the complex needs of children with ASD are met.Contribution: The study contributes to understanding of the challenges faced by teachers of children with ASD in providing high quality of education and affirm sound basis of advance information to monitor and evaluate the education of children with ASD in special public schools, which is within the scope of the journal.

Maternal mortality is preventable in Lebanon: A case series of maternal deaths to identify lessons learned using the "Three Delays" model.

To identify the lessons learned from women who died during pregnancy or childbirth in Lebanon between 2018 and 2020. This is a case series and synthesis of maternal deaths between 2018 and 2020 that were reported by healthcare facilities to the Ministry of Public Health in Lebanon. The notes recorded from the maternal mortality review reports were analyzed using the "Three Delays" model to identify preventable causes and lessons learned. A total of 49 women died before, during, or after childbirth, with hemorrhage being the most frequent cause (n = 16). The possible factors that would have prevented maternal deathsincluded a prompt recognition of clinical severity, availability of blood for transfusion and magnesium sulfate for eclampsia, adequate transfer to tertiary care hospitals comprising specialist care, and involvement of skilled medical staff in obstetric emergencies. Many maternal deaths in Lebanon are preventable. Better risk assessment, use of an obstetric warning system, access to adequately skilled human resources and medications, and improved communication and transfer mechanisms between private and tertiary care hospitals may avoid future maternal deaths.

Designing an eSports intervention for middle-aged and older adults in Hong Kong: Social marketing approach.

This study examined the perceptions and experiences of middle-aged and older adult participants in electronic sports (eSports) in Hong Kong (HK), China, by using the social marketing (SM) approach. This qualitative study applied SM approach to the design of a center-based eSports intervention for middle-aged and older adults in HK. Interviews were conducted with 39 adults stratified in terms of age (i.e., 45-64 vs. ≥65 years) and experience with eSports. Ten administrators working in community elderly centers were invited for semistructured interviews. Thematic analysis was performed on the data by incorporating SM. Main findings are presented in terms of five P's. The product component of an eSports intervention includes the foundation of eSports (e.g., safety, eSports training), suitable games for older adults, and professional equipment (e.g., large-screen devices and motion-controlled Nintendo Switches). The price component comprises affordability and the frequency and duration of each eSport session, and the place component includes accessibility and spaces to play eSports. The promotion component should be educational in nature and can incorporate free trials and gaming days, short films about older adults playing eSports, promotional channels, physical evidence and annual eSports competitions. The people component consists of support from administrators and the center in charge, the availability of skilled program instructors and staff, and appropriate partnering, team sizes and instructor-to-participant ratios. The 5P's enhance the design of future center-based eSports interventions and can help researchers and practitioners determine which aspects encourage middle-aged and older adults to participate in eSports.

Impact of Cofacilitated, Collaborative, Recovery-Oriented Practice Training on Clinical Mental Health Workforce Competencies.

The authors aimed to evaluate the impact of a staff development training program informed by the collaborative recovery model (CRM) on staff outcomes in the largest implementation of CRM undertaken by a public clinical mental health service. Implementation spanned community, rehabilitation, inpatient, and crisis programs for children and youths, adults, and older persons in metropolitan Melbourne, 2017-2018. The CRM staff development program was cofacilitated and coproduced by trainers with clinical and lived experience of recovery (including caregivers) and delivered to the mental health workforce (N=729, including medical, nursing, allied health, lived experience, and leadership staff). The 3-day training program was supplemented by booster training and coaching in team-based reflective practice. Pre- and posttraining measures assessed changes in self-reported CRM-related knowledge, attitudes, skills, and confidence and in the perceived importance of CRM implementation. Staff definitions of recovery were analyzed to understand changes in language related to collaborative recovery. The staff development program significantly (p<0.001) improved self-rated knowledge, attitudes, and skills in applying CRM. At booster training, improvements in attitudes and self-confidence in implementing CRM were maintained. Ratings of the importance of CRM and confidence in the organization's implementation did not change. Definitions of recovery illustrated development of shared language throughout the large mental health program. The cofacilitated CRM staff development program achieved significant changes in staff knowledge, attitudes, skills, and confidence and changes in language related to recovery. These results suggest that implementing collaborative, recovery-oriented practice in a large public mental health program is feasible and can result in broad and sustainable change.

Determining the Effect of Process Innovation on Financial Performance of Deposit Taking Saving and Credit Cooperative Societies in Laikipia County, Kenya

Purpose: To determine the effect of process innovation on financial performance of deposit taking saving and credit cooperative societies in Laikipia County, Kenya &#x0D; Methodology: The study used descriptive research design to collect data from nine deposit taking Saccos in Laikipia County. Specifically, the target population were 118 respondents who included 22 departmental managers and 96 support staff selected using census method. Notably, the study collected both primary and secondary data whereby primary data was collected in form of questionnaires from departmental managers and support staff. Secondary data was collected from financial reports such as income statement, whereby various financial ratios such as return on assets, return on equity, gross profit, net profit, liquidity ratio were noted. Further, the study conducted a pilot study in Bingwa Sacco in Kirinyaga County whose managing director, 3 departmental managers and 13 technical staff took part. The study also measured reliability using Cronbach Alpha Coefficient method while face, content and construct types of validity were measured. Further, SPSS software version 24 was used to analyze and generate various statistical reports whereby, in the analysis of the questionnaire, the study examined and generated descriptive statistics such as frequency, percentage and mean. Additionally, the study generated various linear regression statistics such as model summary and ANOVA of each independent variable. Thereafter the study generated inferential statistics to test the general model.&#x0D; Results: The results indicated that 92(82%) strongly agreed and 16(14%) agreed on a mean of 4.75, that there were effective complaint management processes which clients used in case of dissatisfaction. Further, 74(67%) strongly agreed and 17(15%) agreed on a mean of 4.23 that cheque clearance took less time since the system was able to process it faster. That notwithstanding, 74(67%) strongly disagreed and 21(19%) disagreed on a mean of 2.23, the Sacco management had invested a lot in equipping the Sacco with good working computerized systems. In addition, 65(58%) strongly disagreed and 31(28%) disagreed on a mean of 2.29, that the Sacco had established updated system checks to facilitate less downtime during financial transactions. Additionally, R was 0.864 while R-square was 0.747 at a Durbin Watson of 1.601. This meant that process innovation predicted 74.7% on financial performance which was positively correlated d at 1.601. Further, the p-value was 0.022 which was below than 0.05 and therefore, the study rejected null hypothesis.&#x0D; Unique contribution to theory, policy and practice: The study concluded that Sacco’s bid to incorporate ICT to assist in financial transaction such as having enough servers and skilled staff was still low hence increased system downtimes. Consistent downtime exposed the client deposits to cyber theft since the hackers noted this weakness and used to their advantage to commit crime. Therefore, the Sacco management should invest in secure servers to protect client’s information from unauthorized access or use. This could also involve wither hiring new ICT personnel or sharpening the skills of the current ICT staff through training and development. Additionally, the Sacco staff should maintain a strict policy of ensuring that they do not issue passwords to anyone or leave their computers logged in in their absence even when there is a system failure to reduce cyber hacking. Further, the Sacco ICT management should expand their domains to ensure that there are minimal system failures to facilitate smooth flow of operations

Artificial Intelligence in Point-of-Care Testing.

With the projected increase in the global population, current healthcare delivery models will face severe challenges. Rural and remote areas, whether in developed or developing countries, are characterized by the same challenges: the unavailability of hospitals, lack of trained and skilled staff performing tests, and poor compliance with quality assurance protocols. Point-of-care testing using artificial intelligence (AI) is poised to be able to address these challenges. In this review, we highlight some key areas of application of AI in point-of-care testing, including lateral flow immunoassays, bright-field microscopy, and hematology, demonstrating this rapidly expanding field of laboratory medicine.

Pedagogical Leadership in the Educational Management of Peruvian Educational Institutions

Purpose: determine the relationship of pedagogical leadership and educational management considering a primary level educational institution. Theoretical framework: The literature has reported good findings on pedagogical leadership independently from educational management, which is one of the reasons why it was decided to investigate both categories. Design/methodology/approach: Under an exploratory and basic study, with a qualitative, relational approach, the bibliographic analysis was performed, using a documentary guide. Findings: After reviewing and analyzing the articles published in Scopus and other academic platforms, it was shown that pedagogical leadership and educational management maintain a very significant relationship, since by having certain skills of managers, teachers and administrative staff, educational management will be adequate, allowing to improve the results in educational institutions. Research, Practical &amp; Social implications: It is suggested that researchers study pedagogical leadership and educational management together, using a mixed survey and interview approach. Originality/value: It was found that as long as the authorities of the educational entities exercise pedagogical leadership in each of the administrative and academic activities, there will be a better teamwork that will allow achieving institutional goals through efficient educational management.

A randomized clinical trial testing two implementation strategies to promote the treatment of tobacco dependence in community mental healthcare

IntroductionPeople with serious mental illness (SMI) are more likely to smoke and less likely to receive tobacco treatment. Implementation strategies may address clinician and organizational barriers to treating tobacco in mental healthcare. MethodsA cluster-randomized trial (Clinic N=13, Client N=610, Staff N=222) tested two models to promote tobacco treatment in community mental healthcare: standard didactic training vs. Addressing Tobacco Through Organizational Change (ATTOC), an organizational model that provides clinician and leadership training and addresses system barriers to tobacco treatment. Primary outcomes were changes in tobacco treatment from clients, staff, and medical records. Secondary outcomes were changes in smoking, mental health, and quality of life (QOL), and staff skills and barriers to treat tobacco. ResultsClients at ATTOC sites reported a significant increase in receiving tobacco treatment from clinician at weeks 12 and 24 (ps<0.05) and tobacco treatments and policies from clinics at weeks 12, 24, 36, and 52 (ps<0.05), vs. standard sites. ATTOC staff reported a significant increase in skills to treat tobacco at week 36 (p=0.05), vs. standard sites. For both models, tobacco use medications, from clients (week 52) and medical records (week 36), increased (ps<0.05), while perceived barriers decreased at weeks 24 and 52 (ps<0.05); 4.3% of clients quit smoking which was not associated with model. QOL and mental health improved over 24 weeks for both models (ps<0.05). ConclusionsStandard training and ATTOC improve use of evidence-based tobacco treatments in community mental healthcare without worsening mental health, but ATTOC may more effectively address this practice gap.

Factors affecting employee social relations and happiness: SM-PLUS approach

Employee happiness plays a significant role in the functioning of a contemporary business organization as it helps to boost the skills and abilities of employees and assists them to function better in their jobs. Moreover, it helps to create a cordial relationship between the employer and the employee, which further assists in retaining skilled staff within an organization. Employee happiness further helps an organization to achieve successful operational channels as well as organizational growth and sustained development. The aim of this research is to study a set of aspects that affect employee-to-employee relationships and how these relations influence happiness, which, in turn, helps an organization to flourish in the current competitive business environment. The selected aspects are employee engagement, employee emotions, shared values, employee knowledge, employee rewards, employee empowerment and work performance.A set of hypotheses have been developed and tested in real business contexts in addition to the study’s model. Results indicated that all the studied concepts affected employee-employee relationships inside the workplace and enhanced the business workplace environment and helped in shaping employee happiness. This paper presents additional practical and theoretical implications in addition to a number of future research venues.

Development of the educational leadership scale for nursing students: a methodological study

BackgroundEducational leadership is one of the most demanding skills for healthcare staff to enhance the quality of health care. There is a need for a scale to evaluate the educational leadership levels of nurses. The objective of this study was to develop and examine the validity and reliability of the Education Leadership Scale for Nursing Students.MethodsData were collected from 280 Turkish nursing students. The validity and reliability of the tool were confirmed with exploratory and confirmatory factor analysis, Cronbach’s alpha and Pearson correlation. The scale was developed in five stages (reviewing the literature, developing items, sending scale items to the experts for content validity index, piloting test with students, performing the validity and reliability analysis of the tool).ResultsThe Educational Leadership Scale for Nursing Students consisted of 19 items and a three factor structure. Confirmatory factor analysis results showed that there was a sufficient model fit. Construct validity was verified, and Cronbach’s α level of all factors was found to be greater than 0.70.ConclusionsThe currently developed scale can measure the educational leadership characteristics of nursing students.

Identifying and prioritising strategies to optimise community gym participation for young adults with cerebral palsy: an e-Delphi study

Purpose Identify and prioritise strategies to optimise physical activity participation in the community gym setting for young adults with cerebral palsy. Methods An e-Delphi method was implemented over three rounds with four stakeholder groups (young adults with cerebral palsy, their families, gym staff or exercise professionals, and health professionals). Strategies for change were identified by the stakeholders in round 1. In rounds 2 and 3, strategies for change were rated on the importance for implementation using a 7-point Likert scale (1 being lowest importance, 7 being highest). The consensus was achieved if ≥70% of participants identified a strategy as high importance. Results Seventy participants (20 young adults 10 family members, 21 health professionals, and 19 exercise professionals) identified 83 strategies for improving gym participation. Of these, 44 strategies met the consensus criteria. The highest priority strategies related to changing the physical environment, addressing cost barriers, gym staff training, and developing partnerships between sectors. Conclusions Addressing physical accessibility, cost of attendance and the skills of gym staff were agreed upon by the stakeholder groups as priority areas for future resource allocation and research translation. Clinicians and community leisure facilities must work with consumers to implement strategies in their local contexts.

Assessment of implementation of smart university management system: The case of Kazakh Ablai Khan University of International Relations and World Languages

The effective functioning of a smart university management system significantly improves higher education institutions’ competitiveness. This study aims to assess the implementation of a smart university management system on the example of Kazakh Ablai khan International Relations and World Languages University. The paper considers elements of a smart university system (smart learning technology infrastructure, smart faculty staff, and smart students) from the university managers’ and students’ viewpoints using the stepwise algorithm to raise the university’s competitiveness. During the study, 2700 students were surveyed to assess the implementation and operation of smart systems at the university, and ten experts (the expert team consists of deans and head of departments) were interviewed to identify the weights of each element. The survey results showed that the technology infrastructure for smart learning at the university is at a lower level (50%) than the competence of the teaching staff (60%) and students (89%). Furthermore, based on standardized factor scores and the weighted average, the implementation level of a smart university management system is low – C (0.498), where the weighted assessment of smart learning technology infrastructure is 0.2, smart teaching faculty – 0.19, and smart students – 0.108. According to the results, the university management needs to develop the smart learning technology infrastructure (free Wi-Fi, smart education environment, and smart classrooms) and improve the qualifications of its teaching staff (knowledge and skills, content of the courses, and educational process).

The Future Workforce of the Environmental Laboratory

Key TakeawaysThe environmental laboratory workforce is aging out and needs creative solutions to recruit and retain skilled staff to perform physical, microbial, chemical, and radiological tests.There are immediate needs for chemists to work in radiochemistry and to conduct analyses for per‐ and polyfluoroalkyl substances and other contaminants of emerging concern.Promoting the water and wastewater industry and developing the industry workforce require education through public outreach, internships, fellowships, and citizen science.

Development and Delivery of a Hands-On Short Course in Adeno-Associated Virus Manufacturing to Support Growing Workforce Needs in Gene Therapy.

The manufacturing of gene therapy products is a rapidly growing industry bolstered by the tremendous potential of these therapies to provide lifesaving treatment for rare and complex genetic diseases. The industry's steep rise has resulted in a high demand for skilled staff required to manufacture gene therapy products of the expected high quality. To address this skill shortage, more opportunities for education and training in all aspects of gene therapy manufacturing are needed. The Biomanufacturing Training and Education Center (BTEC) at the North Carolina State University (NC State) has developed and delivered (and continues to deliver) a 4-day, hands-on course titled Hands-on cGMP Biomanufacturing of Vectors for Gene Therapy. The course, which consists of 60% hands-on laboratory activities and 40% lectures, aims to provide a comprehensive understanding of the gene therapy production process, from vial thaw through the final formulation step, and analytical testing. This article discusses the design of the course, the backgrounds of the nearly 80 students who have participated in the seven offerings held since March 2019, and feedback from the course participants.

Time and Water

Once a society's water issues are resolved, time becomes its most precious resource. However, water issues are never resolved for long because the world keeps changing and society's capabilities and expectations evolve along with it. As the public's understanding of and engagement with water issues expand, the water industry needs to develop approaches that serve customers today yet keep in mind how water systems should work in the future. AWWA's Water 2050 effort seeks a long-term vision for water, and by anticipating the water industry's future needs, it can also learn to do better now. This issue of Journal AWWA is also forward-looking, starting with an examination of the future of the environmental laboratory workforce. Like many specialty careers in water, this month's cover story highlights how the industry needs creative solutions to recruit and retain skilled staff to address current and future needs. Looking critically at water system operations, another article explores the factors that contribute to water system success and the different channels that should be used to improve performance, including better long-term planning and more coordinated support from stakeholders and regulators. Another feature explores how biofiltration will likely become more widely used as the underlying processes and treatment benefits are better understood, especially in the face of future regulatory changes. These authors highlight how sustainability, resilience, and financial issues are considered in future water systems, as well as how the best ideas from industry and academia cross-pollinate and lead to future breakthroughs. Another article this month describes the Public Protection Classification criteria of communities for home insurance purposes, which is based on the fire flow of the local municipal water system, and the factors that describe the fire flow adequacy of a municipal water system are prone to future changes. Focusing on strategic planning for pipe renewal and replacement, another article provides guidance to water systems using proactive capital improvement that involves scenario analysis to provide systemwide forecasts for planning, budgeting, and optimizing utility assets. And a final article describes how strategically designed and targeted conservation programs can help communities reduce overall water use by employing smart controllers and addressing customers with the most conservation potential. No society's water issues are resolved forever, so for water and wastewater systems, the never-ending cycle of operation, regeneration, and improvement is passed between professionals who must understand the wide reach of current and future water issues. Join AWWA's effort to look forward and consider writing an article for Journal AWWA by contacting me at [email protected].

The COVID-19 drive-through point — screening and testing — first in Poland complex centre experience

Introduction: Rapid widespread of the SARS-CoV-2 virus in early 2020 caused global chaos. In the initial period, a lack of knowledge of epidemiology and viral contamination, as well as no availability of either causal treatment or preventive vaccination, resulted in mass testing of symptomatic individuals as the priority for protection. This study aimed to evaluate the effectiveness and safety of the first COVID-19 (coronavirus disease) drive-through testing model in the Greater Poland Region. Material and methods: The authors demonstrate step-by-step the creation and development of the Centre of Medical Simulation Poznan University of Medical Sciences (PUMS) COVID-19 drive-through testing point for 3.5 million inhabitants in the Greater Poland Region during the 1st through 4th coronavirus pandemic waves. For staff education, low and high-fidelity simulation techniques were used. Additionally, the number of tests performed at the swab point and the efficiency of the developed testing model were evaluated and assessed in all pandemic waves. Results: PUMS POST (point of screening and testing) activity lasted 24 months. Improvement of staff skills developed through simulation training increased the median number of 91 patients tested each day (with a median of 25 tests per hour) during the 1st wave to a maximum of 260 patients tested each day (135 tests per hour) during the 4th wave when the new drive-through POST system was employed (p &lt; 0.001). Conclusion: The present study supported the previous preliminary reports that drive-through systems developed during the COVID-19 pandemic proved to be efficient and safe for mass population testing. Moreover, the Medical Simulation Centre confirmed the effectiveness of staff skills improvement.

The effect of Appraisal Standards setting on Employee Performance in private Universities in Uganda

The study aimed at establishing the relationship between the appraisal standards and performance of employees in selected private universities in Uganda. It was carried out in two universities which were Kampala International University Bushenyi Campus and University of St. Joseph Mbarara. The study was carried out using a self-administered questionnaire and interview guide. It involved the administrative staff of the universities. The study was hence carried out amongst 60 staff members. The results were analysed using the descriptive statistics including frequencies and percentages, the mean distribution and regression analysis was used to analyse the relationship amongst the variable. The study generally revealed that there was a significant relationship between appraisal standards and employee performance. The standards the appraisal focused on were mainly the employee behaviours, competences and achievements. The results indicated that the main behavioural targets were the employees’ relations with colleagues, relations with clients, relations with supervisors and the extent to which employees observed the code of conduct including the disciple. The competences assessed related to relevance of the staff qualifications are assessed, staff members ability to counsel students, the ability to communicate with clients, he staff skills to do the work is assessed and the staff skills to do the work is assessed. On achievement, the study examined the application of appraisal on determining participation and ability to contribute in meetings, the staff performance, the research output, the clients attracted to the organization, the level of attendance to duties and participation in training activities. On the whole the study recommended the need to enhance appraisal standards and ensure that all staff members are aware of the standards that are usually assessed so that they work towards achieving them.

The Impact of Wages on Care Home Quality in England.

In many countries, a large proportion of long-term care staff are paid at, or near, minimum wage, leading to concerns of negative effects on care outcomes. This study analyzed the effect of staff wages on care home quality ratings in England. A national staffing database of long-term care providers was matched with local-area information on needs and supply to construct a 3-year panel (2016-2018) of English care home observations. Using multiple imputation methods to address missing data provided a data set of 12,055 observations of 5,556 care facilities (both residential and nursing homes). We analyzed the effect of the facility-level average hourly wage of care staff on national regulator quality ratings. A measure of the impact of exogenous changes in the national minimum wage on care facilities was used as an instrument for wage. We find that wages positively affect care home quality ratings. Other things equal, a 10% increase in the average hourly wage of direct care workers would lead to a 7.1% increase in the likelihood that a care home will have a high-quality rating. The wage effect on quality was significant when controlling for staff skill mix, measured as the share of registered nurses in nursing home staff. This study provides important evidence of the positive impact that staff pay can have on the quality of long-term care. Our finding has important implications for appropriate levels of pay and the funding of long-term care.