Joint effect of Medicaid census and nursing home factors on the recognition rate of depressive symptoms

OBJECTIVES: To examine the joint effect of Medicaid census and nursing home resident and organizational factors on the recognition rate of depressive symptoms across nursing homes in New York State.

DESIGN: A cross-sectional study of the sample, derived from a combined data set of the 2003 Online Survey Certification and Reporting System (OSCAR) and the 2002 Minimum Data Set (MDS) data was conducted. The study sample included 105,517 resident assessment observations from 593 nursing homes in rural and urban areas of New York State. The study included only the observations of residents aged 65 or older.

RESULTS: The average recognition rate of depressive symptoms was observed in 21.8% of the study sample. Of those resident factors, a higher proportion of residents who were married (b = .014, p < .01) and a higher proportion of residents with cognitive impairment (b = .013, p < .0001) were significantly associated with a higher recognition rate of depressive symptoms. Significant joint effects of Medicaid census and the proportion of African American residents (b = -.0003, p = .07) and the proportion of Hispanic residents (b = -.001, p < .01) on the outcome were also found. Medicaid census and a nursing home's nonprofit status had a joint effect on the recognition rate of depressive symptoms (b = -.011, p < .05). Another significant Medicaid census joint effect with the presence of FT social work staff was found (b = -.012. p < .05).

CONCLUSION: The findings of this study suggest that depressive symptoms may be significantly underrecognized in nursing homes with high Medicaid censuses.