The objective of this study was to determine whether regulation affects the quality of care in licensed and unlicensed board and care homes. Specifically, the study was designed to determine whether an extensive regulatory system is associated with better quality of care and, if such an association is found, to determine whether regulation affects licensed and unlicensed homes differently.
We chose a “polarized” approach to test the main hypothesis. If regulation affects quality of care, the association will be most apparent in the extremes of the regulatory environment. That is, for a given sample size, the best chance of detecting regulatory effects on quality is afforded by restricting the sample to homes located in States with the most extensive and most limited regulatory systems. If licensure status (licensed/unlicensed) is included with regulatory environment as a second factor, the result is a two-factor by two-level (i.e., 2x2) factorial design.
In the sections that follow, we discuss the definition of the study population and the sample design, including the selection of States and the selection of probability-based samples of board and care homes, their staff, and residents. We also summarize our strategies for measurement construction and analysis.