The 130th Annual Meeting of APHA

Abstract #47748

Robert Weech-Maldonado--Award Winner, PhD¹, Dennis G Shea, PhD², and Kristine Elmendorf, MS². (1) Department of Health Policy & Administration, Pennsylvania State University, 116 Henderson Building, University Park, PA 16801, (814) 865-1926, rxw25@psu.edu, (2) Department of Health Policy and Administration, Pennsylvania State University, 116 Henderson Building, University Park, PA 16801

The last 15 years have been turbulent for long-term care, as market and policy changes have had significant impacts on both patients and providers. This study examines the effect of market and policy changes on rural versus urban long-term care facilities in Pennsylvania, covering the spectrum of long-term care providers: nursing homes (NH), assisted living facilities (ALF) and home health agencies (HHA). The study uses data from a survey of all NHs, ALFs, and HHAs in Pennsylvania in 2001. Analysis of variance (ANOVA) and chi-square tests were used to test for differences across the different types of providers. The independent variables consist of operating environment characteristics, interoganizational relationships (IORs), and changes in patient acuity and staffing that resulted from the implementation of Medicare prospective payment system (PPS). Our analysis shows that long-term care providers vary with respect to the operating environment, IORs, and impact of PPS. Nursing homes perceive the greatest number of environmental threats with staffing, Medicare PPS, assisted living growth, and regulation as major concerns. In response, NHs have established external linkages with other NHs, ALFs, and HHAs, entered into managed care, and exercised staffing changes. A high proportion of HHAs are also experiencing a decline in their patient pool and reporting staffing cuts, especially among rural agencies. Recent market and policy changes are placing nursing homes and home health agencies at risk. Policymakers need to develop strategies that will reduce nursing shortages and improve the revenue stream of these providers.

Learning Objectives:

• To analyze whether recent environmental changes in the long-term care industry have unfolded differently in rural and urban populations.
• To examine how long-term care providers (nursing homes, home health agencies, and assisted living facilities) vary with respect to operating environment and strategic behavior.
• To discuss the impact of market and policy changes on long-term care providers.
• To examine the implications of environmental changes on the costs, access, and quality of long-term care.

Keywords: Long-Term Care, Policy/Policy Development

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.