A strong economy and falling unemployment rates are actually harmful to the elderly, according to a report from the Center for Retirement Research at Boston College.

Analysis found that mortality increases more in states with larger shares of their populations in nursing homes, particularly among women. One possible expla­nation is that the quality of care declines in a strong economy when demand for workers grows through­out the economy.

Past research indicates that the ability of healthcare providers to hire staff is influenced by the state of the economy: employment levels in healthcare decline during economic expansions as low-paid, low-skill workers find better jobs elsewhere. “This migration worsens perennial shortages of direct caregivers, such as nursing aides and home health workers,” state the report authors.

“This finding suggests that such shortages may be an important focus of future efforts to improve the quality of health care,” conclude the authors.