Do characteristics associated with nursing home residents vary by race/ethnicity?

This study identifies differences in the predisposing, enabling, and need characteristics of racial/ethnic minorities and non-Hispanic white men and women upon nursing home admission. The data come from the 1999 National Nursing Home Survey of Current Residents and contain 3,798 women of color, 3,787 men of color, 18,719 non-Hispanic white men, and 36,900 non-Hispanic white women. We estimated prevalence differences and 95% confidence intervals for the absolute differences in prevalence. Women of color in nursing homes are more likely than non-Hispanic white women in nursing homes to be bedfast and require assistance with dressing and money management. Men of color in nursing homes are more likely than non-Hispanic white men in nursing homes to require assistance with eating, care of possessions, managing money, securing personal items, and using the telephone. The overall finding suggests that people of color in nursing homes have greater impairments than non-Hispanic whites in nursing homes, and that men of color in nursing homes have greater impairment than any other race or gender categories.     

Determinants of nursing home choice: Does reported quality matter?

Quality report cards addressing information asymmetry in the health care market have become a popular strategy used by policymakers to improve the quality of care for older people. Using individual level data from the largest German sickness fund merged with institutional level data, we examine the relationship between reported nursing home quality, as measured by recently introduced report cards, nursing home prices, nursing home's location, and the individual choice of nursing homes. Report cards were stepwise introduced as of 2009, and we use a sample of 2010 that includes both homes that had been evaluated at that time and that had not yet been. Thus, we can distinguish between institutions with above and below average ratings as well as nonrated nursing homes. We find that the probability of choosing a nursing home decreases in distance and price. However, we find no economically significant effect of reported quality on individuals' choice of nursing homes.     

Do financial incentives influence the hospitalization rate of nursing home residents? Evidence from Germany

Efficient health‐care provision for nursing home residents is a concern in many OECD (Organization for Economic Cooperation and Development) countries. This paper analyzes whether nursing homes respond to financial incentives when deciding whether to hospitalize their residents. In Germany, reimbursements for nursing homes are reduced after a defined number of days when a resident stays in a hospital instead of a nursing home. As a result of a federal law introduced in 2008, some German states had to change the point at which reimbursements to nursing homes are reduced so that reductions are made from Day 4 instead of Day 1 of a resident's absence. This exogenously raised an incentive for the nursing homes affected to hospitalize residents especially for an expected short‐term stay. This analysis exploits the introduction of the law in a difference‐in‐difference approach, using market‐wide German‐DRG files covering all hospital patients discharged from hospitals to nursing homes from 2007 to 2011. The results suggest an increase of approximately 11% in short‐term hospital stays as a consequence of the longer reimbursement period introduced by the law.     

Everyday doings in a nursing home – described by residents and staff

Objective: For many groups of elderly people it is important to be active, which can be hindered by disabilities that come with age. Research has progressed in this area but mostly concerns the elderly living at home. The aim of this study was to examine how residents and staff at a nursing home described the residents’ everyday doings. Methods: A nursing home was selected in which 15 of the residents and six of the staff were interviewed about the residents’ activities during an ordinary day and week. Results: The material was analysed using qualitative content analysis in which two categories emerged: shared doings and individual doings. The shared doings were important for supporting the residents in their social and physical activities, but participation in these was often hampered by reduced functions. The individual doings, where the residents’ own interests can be promoted, were also hampered by their disabilities. Being able to be active and having something to do were emphasized, either continuing with previous activities or participating in shared activities at the nursing home. Conclusions: Receiving care and being forced to adjust to the context at the nursing home had a significant impact on the residents’ daily doings. Most of the residents needed help to be able to continue performing their activities or to find new ones. The social environment consisting of other residents and staff also influenced the residents’ activities.     

A comparison of home care clients and nursing home residents: can community based care keep the elderly and disabled at home?

Admission cohorts from the Michigan Medicaid Home and Community-Based Waiver program and Ohio nursing homes were compared on measures of resource utilization including a modified Resource Utilization Groups (RUG-III) system, Activities of Daily Living (ADLs), and overall case mix. We found that, contrary to previous research, the two samples were remarkably similar across RUG-III categories. However, the nursing home sample was more functionally impaired on measures of ADL functioning and overall case mix. Results of this study may inform policymakers and providers of the potential for maintaining the appropriate population in the home with government-funded home care.     

Distress among rural residents: Does employment and occupation make a difference?

Objective:  This study investigates the relationship between levels of mental health and well-being (in terms of self-reported levels of distress) with employment and occupational status of rural residents, to better inform the provision of mental health services to those in greatest need in rural communities.
Method:  A stratified random sample of community residents in rural and remote New South Wales with over-sampling of remote areas as first stage of a cohort study. Psychological distress was measured using Kessler-10, inclusive of additional items addressing functional impairment (days out of role). Occupational data were classified using Australian and New Zealand Standard Classification of Occupations categories.
Results:  A total of 2639 adults participated in this baseline phase. Among them, 57% were in paid employment, 30% had retired from the workforce, 6% were permanently unable to work and 2% were unemployed. The highest levels of distress and functional impairment were reported in those permanently unable to work and the unemployed group with rates of 'caseness' (likely mental health disorder) varying from 57% to 69%, compared with 34% of farmers and farm managers and 29% of health workers ( P <  0.01).
Conclusion:  The rural unemployed suffer considerable psychological distress and 'disability', yet they are not the target of specific mental health promotion and prevention programs, which are often occasioned by rural adversity, such as drought, and delivered through work-based pathways. Policy-makers and health service providers need to consider the needs of the rural unemployed and those permanently unable to work and how they might be addressed.     

How well trained are nursing home administrators?

Nursing home administrators represent wide variations in academic training. General education levels do not seem to affect administrative preparation in key domains of practice--specific academic fields of study are more relevant. Hence, sole emphasis on higher educational requirements for licensure appears to be a misdirected strategy for improving quality of care and enhancing management efficiencies in nursing homes. Educational paradigms studied have strengths and weakness in furnishing various job skills. These results are helpful in defining strategic actions for addressing both current deficiencies and future training needs. A specialized long-term care model that incorporates appropriate clinical and business skills is recommended. The roles of continuing education and executive educational offerings also need streamlining. These initiatives would require a joint effort from policymakers, academicians, and practitioners.     

Is higher nursing home quality more costly?

Widespread issues regarding quality in nursing homes call for an improved understanding of the relationship with costs. This relationship may differ in European countries, where care is mainly delivered by nonprofit providers. In accordance with the economic theory of production, we estimate a total cost function for nursing home services using data from 45 nursing homes in Switzerland between 2006 and 2010. Quality is measured by means of clinical indicators regarding process and outcome derived from the minimum data set. We consider both composite and single quality indicators. Contrary to most previous studies, we use panel data and control for omitted variables bias. This allows us to capture features specific to nursing homes that may explain differences in structural quality or cost levels. Additional analysis is provided to address simultaneity bias using an instrumental variable approach. We find evidence that poor levels of quality regarding outcome, as measured by the prevalence of severe pain and weight loss, lead to higher costs. This may have important implications for the design of payment schemes for nursing homes.     

Can family caregiving substitute for nursing home care?

Informal care should be a substitute for nursing homes but empirical evidence often suggests the opposite. This may be because informal care receipt is positively correlated with unobserved negative health characteristics. We exploit variation in children's characteristics as instruments for informal care to provide Two-Stage Least Squares (TSLS) estimates of nursing home use among a sample of 6855 individuals from the 1993-2000 waves of the AHEAD survey. While OLS results suggest informal care is associated with greater future nursing home risk, TSLS estimates show that receipt of informal care statistically and substantially reduces the risk of nursing home entry. This finding has implications for Medicaid and private long-term care insurance markets.     

Qualitative analyses of nursing home residents’ quality of life from multiple stakeholders’ perspectives

Quality of Life Research - Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these...     

Does quality pay for nursing homes?

Using physical restraints, urethral catheterization, pressure ulcers, psychotropic medication use, and contractures as quality indicators, this research examines whether the quality of nursing homes is associated with private-pay census. The primary data source was the 2000, 2001, and 2002 Online Survey Certification And Recording (OSCAR) data, which is nationally representative data containing information for approximately 17,000 nursing homes. The results of this study suggest that physical restraint use and psychotropic medication use have both a correlative and predictive relationship with private-pay census. Catheterization, pressure ulcers, and contractures are less important. The results of this study are important in two ways. First, the cross-sectional results show that the higher quality nursing homes are likely to have a higher private-pay census. Second, the change score analyses show that nursing homes can increase their private-pay census by increasing quality.     

Does spaced education improve clinical knowledge among Family Medicine residents? A cluster randomized controlled trial

Advances in Health Sciences Education - Spaced education is a learning strategy to improve knowledge acquisition and retention. To date, no robust evidence exists to support the utility of spaced...