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Nursing home performance in resident care in the United States: is it only a matter of for-profit versus not-for-profit?

Published online by Cambridge University Press:  01 April 2008

FREDERIC H. DECKER
FREDERIC H. DECKER*
Affiliation:
National Center for Health Statistics, Centers for Disease Control and Prevention, USA
*
*Correspondence to: Frederic H. Decker, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 3435, Hyattsville, MD 20782, USA. Email: [email protected]
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Abstract:

Poorer resident care in US for-profit relative to not-for-profit nursing homes is usually blamed on the profit motive. But US nursing home performance may relate to Medicaid public financing in a manner qualifying the relationship between ownership and quality. We investigated effects of Medicaid resident census, Medicaid payment, and occupancy on performance. Resource dependence theory implies these predictors may affect discretion in resources invested in resident care across for-profit and not-for-profit facilities. Models on physical restraint use and registered nurse (RN) staffing were studied using generalized estimating equations with panel data derived from certification inspections of nursing homes. Restraint use increased and RN staffing levels decreased among for-profit and not-for-profit facilities when the Medicaid census increased and Medicaid payment decreased. Interaction effects supported a theory that performance relates to available discretion in resource allocation. Effects of occupancy appear contingent on the dependence on Medicaid. Poorer performance among US for-profit nursing homes may relate to for-profit homes having lower occupancy, higher Medicaid census, and operating in US states with lower Medicaid payments compared to not-for-profit homes. Understanding the complexity of factors affecting resources expended on resident care may further our understanding of the production of quality in nursing homes, whether in the US or elsewhere.

Type
Articles
Information
Health Economics, Policy and Law , Volume 3 , Issue 2 , April 2008 , pp. 115 - 140
Copyright
Copyright © Cambridge University Press 2008

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References

Abt Associates Inc (2004), National Nursing Home Quality Measures: User's Manual, Cambridge, MA: Abt Associates; available at www.cms.hhs.gov/NursingHomeQualityInits/35_NHQIArchives.asp#TopOfPageGoogle Scholar
Ai, C. and Norton, E.C.(2003), ‘Interaction terms in logit and probit models’, Economic Letters, 80: 123–129.CrossRefGoogle Scholar
Allison, P.D. and Waterman, R.P. (2002), ‘Fixed-effects negative binomial regression models’, in Stolzenberg, R. (ed.), Sociological Methodology, 32, Boston, MA: Blackwell Publishing, Inc., 247–265.Google Scholar
Anderson, R.A., Hsieh, P., and Su, H. (1998), ‘Resource allocation and resident outcomes in nursing homes: comparison between the best and worst’, Research in Nursing and Health, 21: 297–313.3.0.CO;2-A>CrossRefGoogle ScholarPubMed
Ballinger, G.A. (2004), ‘Using generalized estimating equations for longitudinal data analysis’, Organizational Research Methods, 7(2): 127–150.CrossRefGoogle Scholar
Banaszak-Holl, J.B., Zinn, J.S., and Mor, V. (1996), ‘The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective’, Health Services Research, 31(1):97–117.Google ScholarPubMed
Boos, D.D. (1992), ‘On generalized score tests’, American Statistician, 46(4): 327–333.CrossRefGoogle Scholar
Bureau of Health Professions, US Health Resources and Services Administration (2005), ‘Area Resource File’; available at www.arfsys.comGoogle Scholar
Castle, N.G. (2000), ‘Differences in nursing homes with increasing and decreasing use of physical restraints’, Medical Care, 38(12): 1154–1163.CrossRefGoogle ScholarPubMed
Castle, N.G., Fogel, B., and Mor, V. (1997), ‘Risk factors for physical restraint use in nursing homes: pre- and post-implementation of the nursing home reform act’, Gerontologist, 37(6):737–747.CrossRefGoogle ScholarPubMed
Castle, N.G. and Mor, V. (1998), ‘Physical restraints in nursing homes: a review of the literature since the nursing home reform act of 1987’, Medical Care Research and Review, 55(2):139–170.CrossRefGoogle ScholarPubMed
Centers for Medicare and Medicaid Services (CMS) (1998), ‘Resident census and conditions of residents’(Form CMS-672); available at www.cms.hhs.gov/CMSForms/Google Scholar
Centers for Medicare and Medicaid Services (CMS) (2003), Health Care Industry Market Update: Nursing Facilities, Baltimore, MD:Centers for Medicaid and Medicare Services.Google Scholar
Centers for Medicare and Medicaid Services (CMS) (2004), State Operations Manual, (Publication 100-07); available at www.cms.hhs.gov/Manuals/IOM/list.asp#TopOfPageGoogle Scholar
Centers for Medicare and Medicaid Services (CMS) (2006), ‘Wage index file’ (Historical); available at www.cms.hhs.gov/AcuteInpatientPPS/FFD/list.asp?listpage=8Google Scholar
Cohen, J.W. and Spector, W.D. (1996), ‘The effect of Medicaid reimbursement on quality of care in nursing homes’, Journal of Health Economics, 15:23–48.CrossRefGoogle ScholarPubMed
Consumer Report (2006), Nursing Home Guide: Special Edition; available at www.consumerreports.org/cro/health-fitness/nursing-home-guide/0608_nursing-home-guide.htmGoogle Scholar
Davis, M.A. (1991), ‘On nursing home quality: a review and analysis’, Medical Care Review, 48(2):129–166.CrossRefGoogle Scholar
Decker, F.H. (2006), ‘Nursing staffing and the outcomes of nursing home stays’, Medical Care, 44:812–821.CrossRefGoogle ScholarPubMed
Decker, F.H. (2008), ‘The relationship of nursing staff to the hospitalization of nursing home residents’, Research in Nursing and Health, 31:forthcoming. Published online 28 January 2008, doi: 10.1002/nur.20249CrossRefGoogle Scholar
Decker, F.H., Dollard, K.J. and Kraditor, K.R. (2001), ‘Staffing of nursing services in nursing homes: present issues and prospects for the future’, Seniors Housing and Care Journal, 9:3–26.Google Scholar
Edwards, D.J. (2002), ‘Not-for-profits feel budgetary burn’, Nursing Home/Long Term Care Management, 51(December).Google Scholar
Florida, Agency for Health Care Administration (2007), Nursing Home Guide; available at http://ahcaxnet.fdhc.state.fl.us./nhcguide/Google Scholar
Global Insight (2005), Health-Care Cost Review, Second Quarter 2005, Boston, MA: Global Insight.Google Scholar
Grabowski, D.C. (2001), ‘Medicaid reimbursement and the quality of nursing home care’, Journal of Health Economics, 20:549–569.CrossRefGoogle ScholarPubMed
Grabowski, D.C. and Angelelli, J.J. (2004), ‘The relationship of Medicaid payment rates, bed constraint policies, and risk-adjusted pressure ulcers’, Health Services Research, 39(4, Part 1):793–812.CrossRefGoogle ScholarPubMed
Grabowski, D.C. and Hirth, R.A. (2003), ‘Competitive spillovers across non-profit and for-profit nursing homes’, Journal of Health Economics, 22:1–22.CrossRefGoogle ScholarPubMed
Grabowski, D.C., Feng, Z.Intrator, O. and Mor, V. (2004), ‘Recent trends in state nursing home payment policies’, Health Affairs, W4(Web Exclusive): W363–W373.Google ScholarPubMed
Harrington, C. (2001), ‘Regulating nursing homes: residential nursing facilities in the United States’, British Medical Journal, 323(1 September): 507–510.CrossRefGoogle ScholarPubMed
Harrington, C., Cassel, C.Estes, C.L.Woolhandler, S. and Himmelstein, D.U. (1991), ‘A national long-term care program for the United States: a caring vision’, Journal of the American Medical Association, 266(21):3023–3029.CrossRefGoogle ScholarPubMed
Harrington, C., Woolhandler, S.Mullan, J.Carrillo, H. and Himmelstein, D.U. (2001), ‘Does investor ownership of nursing homes compromise the quality of care?’, American Journal of Public Health, 91(9):1452–1455.CrossRefGoogle ScholarPubMed
Harrington, C. and Swan, J.H. (2003), ‘Nursing home staffing, turnover, and case mix’, Medical Care Research and Review, 60(3):366–392.CrossRefGoogle ScholarPubMed
Health Care Financing Administration (HCFA) (2000a), ‘Nurse staffing in US nursing homes’, in Report to Congress: Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Baltimore, MD:HCFA (now Centers for Medicare and Medicaid Services).Google Scholar
Health Care Financing Administration (HCFA) (2000b), ‘Data sources of nursing home nurse staffing analysis, OSCAR: reliability and validity analysis’, in Report to Congress: Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Baltimore, MD: HCFA (now Centers for Medicare and Medicaid Services).Google Scholar
Hedeker, D. and Gibbons, R.D. (2006), Longitudinal Analysis, Hoboken, NJ:Wiley.Google Scholar
Hillmer, M.P., Wodchis, W.P.Gill, S.S.Anderson, G.M. and Rochon, P.A. (2005), ‘Nursing home profit status and quality of care: is there any evidence of an association’, Medical Care Research and Review, 62(2):139–166.CrossRefGoogle ScholarPubMed
Hirth, R.A. (1999), ‘Consumer information and competition between non-profit and for-profit nursing homes’, Journal of Health Economics, 18:219–240.CrossRefGoogle ScholarPubMed
Holmes, J.S. (1996), ‘The effects of ownership and ownership change on nursing home industry costs’, Health Services Research, 31(3):327–346.Google ScholarPubMed
Horn, S.D., Buerhaus, P.Bergstrom, N. and Smout, R.J. (2005), ‘RN staffing time and outcomes of long-stay nursing home residents’, American Journal of Nursing, 105(11):58–70.CrossRefGoogle ScholarPubMed
Jaccard, J. (2001), Interaction Effects in Logistic Regression, Thousand Oaks, CA:Sage.CrossRefGoogle Scholar
Jaccard, J. and Turrisi, R. (2003), Interaction Effects in Multiple Regression: Second Edition, Thousand Oaks, CA:Sage.CrossRefGoogle Scholar
Konetzka, R.T., Yi, D.Norton, E.C. and Kilpatrick, K.E. (2004), ‘Effects of Medicare payment changes on nursing home staffing and deficiencies’, Health Services Research, 39(3):463–487.CrossRefGoogle ScholarPubMed
Konetzka, R.T., Norton, E.C.Sloane, P.D.Kilpatrick, K.E. and Stearns, S.C. (2006), ‘Medicare prospective payment and quality of care for long-stay nursing facility residents’, Medical Care, 44(3): 270–276.CrossRefGoogle ScholarPubMed
Kramer, A.M. and Fish, R. (2001), ‘The relationship between nurse staffing levels and the quality of nursing home care’, in Phase II of final report to Congress: Appropriateness of minimum nurse staffing ratios in nursing homes (Chapter 2), Baltimore, MD:Centers for Medicare and Medicaid Services.Google Scholar
Liang, K. and Zeger, S.L. (1986), ‘Longitudinal data analysis using generalized linear models’, Biometrika, 73(1):13–22.CrossRefGoogle Scholar
Massachusetts, Department of Public Health, Division of Health Care Quality (2007), Numeric Values for Scope and Severity Ratings, available at www.mass.gov/dph/qtool2/scoring_matrices.htmGoogle Scholar
Meyer, M.H. (2001), ‘Medicaid reimbursement rates and access to nursing homes’, Research on Aging, 23(5):532–551.CrossRefGoogle Scholar
Meiners, M.R. (1982), ‘An econometric analysis of the major determinants of nursing home costs in the United States’, Social Science and Medicine, 16:887–898.CrossRefGoogle ScholarPubMed
Norton, E.C. (2000), ‘Long-term care’, in Culyer, A.J. and Newhouse, J.P. (eds), Handbook of Health Economics (Volume 1), New York, NY:Elsevier Science BV, pp. 955–994.CrossRefGoogle Scholar
Office of Inspector General (2003), Nursing Home Deficiency Trends and Survey and Certification Process Consistency, Washington, DC:Office of Inspector General, US Department of Health and Human Services (OEI-02-01-00600).Google Scholar
O'Neill, C., Harrington, C.Kitchener, M. and Saliba, D. (2003), ‘Quality of care in nursing homes: an analysis of relationships among profit, quality, and ownership’, Medical Care, 41(12): 1318–1330.Google ScholarPubMed
Pfeffer, J. and Salanick, G.R. (1978), The External Control of Organizations: A Resource Dependence Perspective, New York, NY:Harper & Row.Google Scholar
Phillips, C.D., Hawes, C.Mor, V.Fries, B.E.Morris, J.N. and Nennstiel, M.E. (1996), ‘Facility and area variation affecting the use of physical restraints in nursing homes’, Medical Care, 34:1149–1162.CrossRefGoogle ScholarPubMed
Reuters Health (31 August 2001), ‘For-profit nursing homes offer worse care’, available at http://ltc-usa.com/LTC/Articles/fpnhworse.htmGoogle Scholar
SAS Institute (2003), SAS Software Release 9.1.3., Cary, NC:SAS Institute Inc.Google Scholar
SAS Institute (2004), SAS/STAT 9.1® User's Guide, Cary, NC:SAS Institute Inc.Google Scholar
Scanlon, W.J. (1980), ‘A theory of the nursing home market’, Inquiry, 17(Spring): 25–41.Google ScholarPubMed
Smith, V., Ramesh, R.Gifford, K.Ellis, E. and Wachino, V. (2003), States Respond to Fiscal Pressure: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2003 and 2004, Washington, DC:Henry J. Kaiser Family Foundation.Google Scholar
Spector, W.D., Selden, T.M. and Cohen, J.W. (1998), ‘The impact of ownership type on nursing home outcomes’, Health Economics,7:639–653.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Tsai, A.G. and Kinosian, B. (2003), ‘The association between profit levels and quality of care in California nursing homes’, Medical Care, 41(12): 1315–1317.CrossRefGoogle ScholarPubMed
US General Accounting Office (2002a), Nursing Homes: Public Reporting of Quality Indicators Has Merit, but National Implementation is Premature, Washington, DC: US General Accounting Office [now Government Accountability Office] (GAO-03-187).Google Scholar
US General Accounting Office (2002b), Skilled Nursing Facilities: Available Data Show Average Nursing Staff Time Changed Little After Medicare Payment Increase, Washington, DC: US General Accounting Office [now Government Accountability Office] (GAO-03-176).Google Scholar
US General Accounting Office (2003), Medicaid Nursing Home Payments: States’ Payment Rates Largely Unaffected by Recent Fiscal Pressures, Washington, DC: US General Accounting Office [now Government Accountability Office] (GAO -04-143).Google Scholar
Weech-Maldonado, R., Meret-Hanke, L.Neff, M.C. and Mor, V. (2004), ‘Nurse staffing patterns and quality of care in nursing homes’, Health Care Management Review, 29(2):107–116.CrossRefGoogle ScholarPubMed
Zeger, S.L. and Liang, K. (1986), ‘Longitudinal data analysis for discrete and continuous outcomes’, Biometrics, 42(1):121–130.CrossRefGoogle ScholarPubMed
Zheng, B. (2000), ‘Summarizing the goodness of fit of generalized linear models for longitudinal data’,Statistics in Medicine,19:1265–1275.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Zinn, J.S., Weech, R.J. and Brannon, D. (1998), ‘Resource dependence and institutional elements in nursing home TQM adoption’, Health Services Research, 33(2): 261–273.Google ScholarPubMed