264739 Transition to Person-Centered Care in U.S. Nursing Homes: Medicaid Reimbursement Policies and Nursing Home Attributes Associated with Culture Change Adoption

Tuesday, October 30, 2012 : 4:30 PM - 4:42 PM

Susan Miller, PhD , School of Public Health, Brown University, Warwick, RI
Jessica Looze, MA , Center for Gerontology & Health Care Research, Brown University, Providence, RI
Melissa Clark, PhD , Public Health-Epidemiology, Brown University, Providence, RI
Samantha Sterns, PhD , US Census Bureau, Bethesda, MD
Michael Lepore, PhD , Research & Evaluation, Planetree, Atlanta, GA
Vincent Mor, PhD , Center for Gerontology & Health Care Research, Brown University, Providence, RI
Objective: To obtain data on culture change (CC) adoption in U.S. nursing homes (NHs) and examine how NH characteristics and states' Medicaid NH reimbursement policies are associated with adoption. Methods: In 2009/10 we surveyed NH Directors of Nursing (DoNs) and Administrators (NHAs) at 4,149 NHs (i.e., a stratified, proportionate random sample of U.S. NHs); contact was achieved at 3,693 NHs. Cooperation rates were: NHAs: 60.8%; DoNs: 59.5%; and Both: 49.5%. Survey questions focused on CC constructs of physical environment, resident-centered/directed care, and staff empowerment. Responses were summed to create domain scores. A composite score was created by equally weighting domain scores and summing these proportions. Using CC scores merged to NH survey data (OSCAR) and other survey responses we conducted descriptive and multivariate linear regression analyses. All analyses were adjusted for survey nonresponse. Results: 85% of U.S. NHs reports some adoption of CC practices, but there was substantial variation in the extent of adoption. (CC scores ranged from 9.4 to 98.4, out of 100.) Multivariate analysis showed that for-profit NH's and those with higher proportions of Medicaid and Black residents have worse CC scores; those with lower DoN, nurse and aide turnover have better scores. In states with Medicaid pay-for-performance systems (with components focusing on person-centered care), composite scores were significantly higher (coefficient 7.1; p<.001). Implications: State policies supporting person-centered care (NH CC) appear to increase adoption, controlling for other organizational characteristics. However, further research is needed to disentangle the causes/effects of the relationships observed in this study.

Learning Areas:
Public health or related public policy

Learning Objectives:
At the conclusion of the session, the participant (learner) in this session will be able to: 1. Describe the extent of adoption of person-centered care (culture change) in U.S. nursing homes in 2010. 2. Describe how nursing home characteristics and Medicaid reimbursement policy is associated with greater or lesser culture change adoption in nursing homes.

Keywords: Nursing Homes, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Susan Miller is Professor of Health Services, Research and Practice (Research) at Brown University. She is co-principal investigator on a NIA-funded project on palliative care in nursing homes and how state LTC policies influence a nursing home’s choice to use hospice care. She was principal investigator on recently completed Retirement Research Foundation-funded study which estimated the prevalence of culture change practices in U.S. nursing homes and identified barriers and facilitators to its implementation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.