Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality

Baldwin, Richard; Chenoweth, Lynn; Rama, Marie dela; Wang, Alex

doi:10.1097/hmr.0000000000000116

Cited by 32 publications

(34 citation statements)

References 37 publications

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“…5,37 Our additional observation associating the number of active residents in an LTC home and the risk of an outbreak may be related to the fact that larger homes require more staff, thereby increasing the number of potential vectors for infection. 38 Our findings linking for-profit status with both the number of resident cases and deaths within COVID-19 outbreaks at LTC homes appears to be mediated in large part by the higher proportion of outdated design standards (which meet or fall below 1972 standards) and chain ownership in for-profit homes, leading to more widespread transmission of COVID-19. Our data are consistent with previous studies that have found small and inconsistent associations between for-profit status and unfavour able outcomes, including an increased risk of infections in LTC residents.…”

Section: Discussionmentioning

confidence: 75%

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Stall

Jones

Brown

et al. 2020

CMAJ

187

216

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ong-term care (LTC) homes have become the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada, with residents of these care homes accounting for more than 80% of the country's deaths. 1-3 Residents of LTC homes are at high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), owing to their congregate living arrangements and exposure to staff with asymptomatic or presymptomatic SARS-CoV-2 infection. 4-6 These residents are also at high risk of morbidity and mortality from COVID-19, as most are older adults with frailty and multimorbidity. 7 There is widespread concern that despite these predisposing risks, LTC homes were both underprepared and underequipped to protect their residents, and questions have arisen as to whether forprofit LTC homes have had worse COVID-19 outcomes. 8,9 In Ontario, Canada's most populous province, all residents of LTC homes receive personal and nursing care as well as subsidized accommodation under a publicly funded LTC program. Regardless of this governmental funding, individual LTC homes can be owned and operated by for-profit, nonprofit or municipal (public) entities. 10 Several observational studies suggest that for-profit LTC homes tend to deliver inferior care across a variety of outcome and process measures. 11,12 These include lower levels and quality of RESEARCH VULNERABLE POPULATIONS

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Section: Discussionmentioning

confidence: 75%

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Stall

Jones

Brown

et al. 2020

CMAJ

187

216

View full text Add to dashboard Cite

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“…Most of LTCFs contain around 100 beds. While smaller facilities are economically disfavored, they provide a more family-like environment and a better quality of care [3], and may be safer in terms of limiting spreading of infections to a large number of residents and staff. The study of 9395 nursing homes in the US showed that the probability of having a COVID-19 case was higher for larger facilities at urban locations [4].…”

Section: Organization and Structure Limitationsmentioning

confidence: 99%

Could we have done better with COVID-19 in nursing homes?

Szczerbińska

2020

Eur Geriatr Med

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According to a communication published on June 4, 2020 by The European Centre for Disease Prevention and Control (ECDC), 31-66% of all deaths, depending on country, due to COVID-19 were among residents in long-term care facilities (LTCF) [1]. The COVID-19 pandemic has uncovered many challenges that have probably existed in LTCF for years, yet few people would have thought they could lead to such dramatic effects. One may blame the new coronavirus for the tragic outcomes, but the bottom line is that LTCFs were simply not prepared for the outbreak, and they were "abandoned" at the time when all health care settings struggled with shortage of personal protective equipment (PPE) and testing [2]. The epidemic is not over yet. Moreover, during the potential next wave, we may once again witness a disaster, if we do not back-reflect on the events of the past months and learn a lesson on how to avoid such a scenario. Therefore, right now is the time to analyse which features of LTC did and did not work, and specify which measures may be undertaken in the nearest weeks, and in the future.

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“…For example, existing literature suggests that quality of care is lower and family experience is worse in nursing facilities that are for profit in nature or owned by corporate chains. [2][3][4][5] Another factor that may be associated with quality is size, with smaller facilities having higher quality than larger ones 6 ; literature also suggests that urban facilities have higher quality than rural ones. 7,8 Nurse staffing ratios have also been associated with nursing home quality, with higher staffing ratios associated with better outcomes.…”

mentioning

confidence: 99%

Performance and Penalties in Year 1 of the Skilled Nursing Facility Value‐Based Purchasing Program

Luke

Crecelius

Maddox

2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Launched in October 2018, Medicareʼs Skilled Nursing Facility Value‐Based Purchasing (SNF VBP) program mandates financial penalties for SNFs with high 30‐day readmission rates. Our objective was to identify characteristics of SNFs associated with provider performance under the program. DESIGN Retrospective cross‐sectional analysis using Nursing Home Compare data for the 2019 SNF VBP. Facility‐level regressions examined the relationship between structural characteristics (nursing home size, rurality, profit status, hospital affiliation, region, and Star Ratings) and patient characteristics (neighborhood income, race/ethnicity, dual eligibility, disability, and frailty) and facility performance. SETTING US Medicare. PARTICIPANTS A total of 14 558 SNFs. MEASUREMENTS The 2019 SNF VBP performance scores and penalties. RESULTS Nationally, 72% (10 436) of SNFs were penalized; 21% (2996) received the maximum penalty of 1.98%. In multivariate analyses, rural SNFs were less likely to be penalized (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.78‐0.92; P < .001; vs urban), while small SNFs were more likely to be penalized (≤70 beds: OR = 1.28; 95% CI = 1.15‐1.42; P < .001; 71‐120 beds: OR = 1.15; 95% CI = 1.05‐1.26; P = .003; vs >120 beds). SNFs with lower nurse staffing had higher odds of penalties (low: OR = 1.15; 95% CI = 1.03‐1.27; P = .010; vs high); nonprofit and government‐owned SNFs had lower odds of penalties (OR = 0.79; 95% CI = 0.72‐0.87; P < .001; government: OR = 0.72; 95% CI = 0.61‐0.84; P < .001; vs for profit); and SNFs with higher Star Ratings had lower odds of penalties (5 stars: OR = 0.47; 95% CI = 0.40‐0.54; P < .001; vs 1 star). In terms of patient population, SNFs located in low‐income ZIP codes (OR = 1.17; 95% CI = 1.03‐1.34; P = .019) or serving a high proportion of frail patients (OR = 1.39; 95% CI = 1.21‐1.60; P < .001) were more likely to be penalized than other SNFs. SNFs with high proportions of dual, black, Hispanic, or disabled patients did not have higher odds of penalization. CONCLUSION Structural and patient characteristics of SNFs may significantly impact provider performance under the SNF VBP. These findings have implications for policy makers and clinical leaders seeking to improve quality and avoid unintended consequences with VBP in SNFs. J Am Geriatr Soc 68:826–834, 2020

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Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality

Cited by 32 publications

References 37 publications

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths

Could we have done better with COVID-19 in nursing homes?

Performance and Penalties in Year 1 of the Skilled Nursing Facility Value‐Based Purchasing Program

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