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APHA Scientific Session and Event Listing

Christopher M. Kelly, PhD, Institute on Aging, University of North Carolina, 720 Martin Luther King, Jr. Blvd., Chapel Hill, NC 27599, 919-843-8065, ckelly@schsr.unc.edu and Lloyd J. Edwards, PhD, Department of Biostatistics, University of North Carolina, 3105H McGavran-Greenberg, Chapel Hill, NC 27599.

The quality of nursing home care remains a concern in the United States. While the proportion of severe nursing home deficiencies (those causing actual harm or the potential of death or serious injury to residents) has fallen since 1999 nationally, among the 50 states regulatory outcomes are inconsistent. In this study, characteristics of the nursing home industry that may help explain interstate variation in the extent of regulatory activity were examined. We obtained state nursing home inspection data from CMS's OSCAR database over a five-year period (2000-2004), Using the linear mixed model for the analysis of longitudinal data, we determined that nursing home ownership, administration, and staffing were associated with the volume and severity of deficiency citations in the 50 states. For-profit and chain-owned nursing homes had a greater number of overall deficiencies, while chain nursing homes had a higher proportion of severe deficiencies. In terms of staffing, higher ratios of registered nurses to nursing home residents led to lower state citation volume, while greater overall nursing staffing (registered nurses, licensed vocational nurses, and certified nursing assistants) led to fewer severe citations. Finally, states with higher minimum education standards for administrators were more likely to have fewer overall nursing home deficiencies; states with higher standards in terms of education, examination, and certification of administrators were more likely to have fewer severe deficiencies. These findings indicate that interstate variation in nursing home regulatory outcomes can be explained, at least in part, by the unique regulatory environment in each state.

Learning Objectives:

• To demonstrate the extent of nursing home quality of care problems in the United States over a five-year period (2000-2004).
• To discuss reasons for interstate variation in nursing home regulatory activity across the 50 states.
• To explore characteristics of the nursing home industry that may influence interstate variation in regulatory activity, such as ownership, staffing and administration.

Keywords: Nursing Homes, Quality of Care

Presenting author's disclosure statement:

Not Answered